Covid-19 Mortality Rate & Risk Factor in People with Diabetes

A population-based cohort study of people with type 1 and type 2 diabetes covering 98% of general practices in England demonstrated associations between potentially modifiable risk factors and COVID-19–related mortality in people with type 1 and type 2 diabetes. Increased COVID-19–related mortality was associated with renal and cardiovascular complications but, independently, also with glycaemic control and body mass index (BMI). In particular, haemoglobin A1c (HbA1c) ≥59 mmol/mol or BMI ≥35 kg/m² are independently associated with increased mortality risks due to COVID-19.

Researchers compared the weekly number of deaths in people with diabetes during the first 19
weeks of 2020 versus the corresponding weeks in 2017, 2018, and 2019, and investigated the
associations between COVID-19–related mortality and risk factors including sex, age, ethnicity,
socioeconomic deprivation, HbA1c, renal impairment (based on eGFR), BMI, tobacco smoking
status, and cardiovascular (CV) comorbidities.

HbA1c

In people with type 2 diabetes, COVID-19–related mortality was significantly higher in those with an HbA1c of 59 mmol/mol (7.6%) or higher than in those with an HbA1c of 48–53 mmol/mol [6.5-7.0%] (hazard ratio [HR] 1.22 [95% CI: 1.15–1.30, P<0.0001] for 59–74 mmol/mol [7.6%–8.9%] and 1.36 [1.24–1.50, P<0.0001] for 75–85 mmol/mol [9.0%–9.9%]).

BMI

For people with type 2 diabetes, compared with a BMI of 25.0–29.9 kg/m2, a BMI of 35.0 to 39.9 kg/m2 had an HR of 1.17 (1.08–1.26, P<0.0001) and a BMI of 40.0 kg/m2 or higher had an HR of 1.60 (1.47–1.75, P<0.0001).

CV and renal disease

55% of COVID-19–related deaths in people with type 2 diabetes had a history of cardiovascular disease (previous myocardial infarction, stroke, or hospitalisation for heart failure) or had renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m²).

Besides standard diabetes care, the authors suggest that recommendations to prevent cardiovascular and microvascular complications might be beneficial to modify some of the risk factors shown to be associated with COVID-19–related mortality.