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Type 1 and Type 2 Diabetes and COVID-19 Related Mortality in England: A Whole Population Study

26 Pages Posted: 19 Jun 2020

See all articles by Emma Barron

Emma Barron

Public Health England

Chirag Bakhai

NHS England & Improvement

Partha Kar

NHS England & Improvement

Andy Weaver

NHS England & Improvement

Dominique Bradley

NHS England & Improvement

Hassan Ismail

NHS England & Improvement

Peter Knighton

NHS Digital

Naomi Holman

NHS England & Improvement

Kamlesh Khunti

University of Leicester - Leicester Diabetes Centre

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

Nick J. Wareham

University of Cambridge - MRC Epidemiology Unit

Bob Young

Diabetes UK - Wells Lawrence House

Jonathan Valabhji

NHS England & Improvement

More...

Abstract

Background: Although diabetes has been associated with COVID-19 mortality, the absolute and relative risks for Type 1 and Type 2 diabetes are unknown.

Methods: A population cohort study assessing risks of in-hospital death with COVID-19 between 1st March and 11th May 2020, including individuals registered with a General Practice in England and alive on February 19th 2020. Multivariate logistic regression examined diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.  

Findings: Of the 61,414,470 individuals registered, 263,830 (0∙4%) had a recorded diagnosis of Type 1 and 2,864,670 (4∙7%) of Type 2 diabetes. There were 23,804 COVID-19 related deaths. One third occurred in people with diabetes: 7,466 (31∙4%) with Type 2 and 365 (1∙5%) with Type 1 diabetes. Crude mortality rates per 100,000 persons over the 72 days for the overall population and for those with Type 1 and Type 2 diabetes were 38∙8 (38∙3-39∙3), 138∙3 (124∙5-153∙3), and 260∙6 (254∙7-266∙6) respectively. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1 and Type 2 diabetes had 3∙50 (3∙15-3∙89) and 2∙03 (1∙97-2∙09) times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes, attenuated to 2∙86 and 1∙81 respectively when also adjusted for previous hospital admissions with coronary heart disease, cerebrovascular disease or heart failure.

Interpretation: This nationwide analysis in England demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.  

Funding: NHS England & Improvement and Public Health England.

Conflict of Interest: Jonathan Valabhji is the National Clinical Director for Diabetes and Obesity at NHS England & Improvement. Partha Kar is National Specialty Advisor for Diabetes and Obesity at NHS England & Improvement. Chirag Bakhai is the Primary Care Advisor to the NHS Diabetes Programme. Bob Young is Clinical lead for the National Diabetes Audit and a trustee of Diabetes UK. Kamlesh Khunti has acted as a consultant and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. Kamlesh Khunti has also received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Pfizer and Boehringer Ingelheim and has served on advisory boards for Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. Naveed Sattar has consulted for Amgen, Astrazeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Pfizer and Sanofi and received grant support from Boehringer Ingelheim.

Keywords: COVID-19; SARS-CoV-2; coronavirus; SARS virus; diabetes; type 1 diabetes; type 2 diabetes; mortality; whole population study; cohort study; COVID-19 related mortality

Suggested Citation

Barron, Emma and Bakhai, Chirag and Kar, Partha and Weaver, Andy and Bradley, Dominique and Ismail, Hassan and Knighton, Peter and Holman, Naomi and Khunti, Kamlesh and Sattar, Naveed and Wareham, Nick J. and Young, Bob and Valabhji, Jonathan, Type 1 and Type 2 Diabetes and COVID-19 Related Mortality in England: A Whole Population Study (5/17/2020). Available at SSRN: https://ssrn.com/abstract=3605225 or http://dx.doi.org/10.2139/ssrn.3605225

Emma Barron

Public Health England

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Chirag Bakhai

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Partha Kar

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Andy Weaver

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Dominique Bradley

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Hassan Ismail

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Peter Knighton

NHS Digital

1 Trevelyan Square
Leeds
United Kingdom

Naomi Holman

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Kamlesh Khunti

University of Leicester - Leicester Diabetes Centre ( email )

Leicester
United Kingdom

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

Glasgow, Scotland
United Kingdom

Nick J. Wareham

University of Cambridge - MRC Epidemiology Unit

United Kingdom

Bob Young

Diabetes UK - Wells Lawrence House

126 Back Church Lane
London
United Kingdom

Jonathan Valabhji (Contact Author)

NHS England & Improvement ( email )

London, SW1A 2NS
United Kingdom

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