COVID-19 risk not equal among people with diabetes
medwireNews: The risk for fatal or critical care unit-treated COVID-19 varies among people with diabetes and can be reasonably well predicted by their clinical history, UK study findings indicate.
Helen Colhoun (University of Edinburgh) and colleagues found that people with diabetes were a significant 40% more likely than those without diabetes to have fatal or critical care unit-treated COVID-19 but noted that risks varied according to factors such as diabetes duration, previous hospital admissions, drug exposures, and comorbidities.
More specifically, 0.3% of 319,349 people with diabetes in Scotland either died from or needed critical care treatment for COVID-19 between March 1, 2020 and July 31, 2020. This was significantly higher than the rate of 0.1% observed among the 5,143,951 people in Scotland who did not have diabetes during that time.
After adjustment for age and sex, people with type 1 diabetes had a significant 2.40-fold increased risk for death or critical care, while those with type 2 diabetes had a significant 1.37-fold increased risk.
However, the researchers also show, for what they believe is the first time, that several other variables impact the risk for severe or fatal COVID-19 after adjustment for age, sex, diabetes duration, and diabetes type.
For example, the risk decreased significantly with decreasing levels of deprivation (odds ratio [OR]=0.38 for most vs least deprived) and was significantly higher for care home residents (OR=16.6) than non-residents.
Also associated with a significantly increased risk for fatal or critical care unit-treated COVID-19 were having a recent (<5 years) hospital admission for diabetic ketoacidosis (OR=2.87) or hypoglycemia (OR=3.18), having retinopathy (OR=1.67), and being an ex- (but not current) smoker (OR=1.30).
Other risk factors included poor glycemic control, decreased estimated glomerular filtration rate, increased albuminuria, having another COVID-19 risk condition (eg, heart disease or asthma), and the receipt of several drug classes, including antidiabetic medication, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, and anticoagulants.
Yet contrary to previous reports, Colhoun and team found that “people who developed fatal or critical care unit-treated COVID-19 had slightly lower blood pressures than those who did not, and that being on antihypertensives was associated with a lower risk than not being on any.”
Using their data, the researchers developed a model containing 15 variables associated with risk for fatal or critical care unit-treated COVID-19, including age, sex, and diabetes type and duration, and found that it could correctly identify high-risk cases 85% of the time. By comparison, the discriminatory power was 76% when only age, sex, and diabetes type and duration were considered.
They say: “This level of predictive accuracy disproves the notion that all people with diabetes have similar risk.”
Writing in The Lancet Diabetes & Endocrinology, Colhoun and co-authors conclude that their findings “should inform shielding policies and vaccine prioritisation strategies” for people with diabetes during the COVID-19 pandemic.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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