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Type 1 and Type 2 Diabetes and COVID-19 Related Mortality in England: A Cohort Study in People with Diabetes

24 Pages Posted: 19 Jun 2020

See all articles by Naomi Holman

Naomi Holman

NHS England & Improvement

Peter Knighton

NHS Digital

Partha Kar

NHS England & Improvement

Jackie O’Keefe

Government of the United Kingdom - NHS Digital

Matt Curley

Government of the United Kingdom - NHS Digital

Andy Weaver

NHS England & Improvement

Emma Barron

Public Health England

Chirag Bakhai

NHS England & Improvement

Kamlesh Khunti

University of Leicester - Leicester Diabetes Centre

Nick J. Wareham

University of Cambridge - MRC Epidemiology Unit

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

Bob Young

Diabetes UK - Wells Lawrence House

Jonathan Valabhji

NHS England & Improvement

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Abstract

Background: Although diabetes has been associated with COVID-19 mortality, its scale and relationships with modifiable risk factors including hyperglycaemia and obesity in Type 1 and Type 2 diabetes remain unclear.

Methods: National diabetes and mortality data in England identified deaths in people with Type 1 and Type 2 diabetes weekly from 1st January 2017 to 1st May 2020. Cox proportional hazards analysis investigated the relationship between risk factors and COVID-19 related death in a cohort alive on 1st January 2020 and followed to 1st May 2020.

Findings: Weekly deaths in Type 1 and Type 2 diabetes more than doubled from the week ending 3rd April 2020 exceeding expected variation (3SD). Among 265,090 people with Type 1 and 2,889,210 people with Type 2 diabetes there were 418 and 9377 COVID-19 related deaths respectively. The adjusted hazard ratio (HR) of HbA1c >86 mmol/mol compared to HbA1c 48-53 mmol/mol was 2·19 (95% CI 1·46-3·29) for Type 1 and 1·62 (95% CI 1·48-1·79) for Type 2 diabetes. The relationship between BMI and COVID-19 mortality was U-shaped; HRs for BMI >40 kg/m2 compared to 25-29.9 kg/m2 were 2·15 (95% 1·37-3·36) and 1·46 (95% CI 1·50-1·79) for Type 1 and Type 2 respectively.

Interpretation: Deaths in people with diabetes in England have more than doubled during the COVID-19 epidemic. Hyperglycaemia and obesity in both Type 1 and Type 2 diabetes were independently associated with increased COVID-19 mortality. Risk factor control could diminish the impact of COVID-19 in diabetes.

Funding: NHS England & Improvement and NHS Digital.

Conflict of Interest: Jonathan Valabhji is 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. 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. K.K. 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. NH carries out Diabetes UK funded research. Emma Barron is Head of Health Intelligence (Diabetes), Public Health England. Chirag Bakhai is Primary Care advisor to the NHS Diabetes Programme. NS 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

Holman, Naomi and Knighton, Peter and Kar, Partha and O’Keefe, Jackie and Curley, Matt and Weaver, Andy and Barron, Emma and Bakhai, Chirag and Khunti, Kamlesh and Wareham, Nick J. and Sattar, Naveed and Young, Bob and Valabhji, Jonathan, Type 1 and Type 2 Diabetes and COVID-19 Related Mortality in England: A Cohort Study in People with Diabetes (5/17/2020). Available at SSRN: https://ssrn.com/abstract=3605226 or http://dx.doi.org/10.2139/ssrn.3605226

Naomi Holman

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Peter Knighton

NHS Digital

1 Trevelyan Square
Leeds
United Kingdom

Partha Kar

NHS England & Improvement

London, SW1A 2NS
United Kingdom

Jackie O’Keefe

Government of the United Kingdom - NHS Digital ( email )

1 Trevelyan Square
Leeds
United Kingdom

Matt Curley

Government of the United Kingdom - NHS Digital

1 Trevelyan Square
Leeds
United Kingdom

Andy Weaver

NHS England & Improvement

London, SW1A 2NS
United Kingdom

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

Kamlesh Khunti

University of Leicester - Leicester Diabetes Centre ( email )

Leicester
United Kingdom

Nick J. Wareham

University of Cambridge - MRC Epidemiology Unit

United Kingdom

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

Glasgow, Scotland
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