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COVID-19 Disease in People with Diabetes in Scotland: Incidence, Severity and Risk Stratification Using Matched Case-Control and Prospective Cohort Studies

42 Pages Posted: 8 Jul 2020

See all articles by Stuart J McGurnaghan

Stuart J McGurnaghan

ealth Protection Scotland (Public Health Scotland)

Amanda Weir

ealth Protection Scotland (Public Health Scotland)

Jen Bishop

Health Protection Scotland (Public Health Scotland)

Sharon Kennedy

Health Protection Scotland (Public Health Scotland)

Luke AK Blackbourn

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Sharon Hutchinson

School of Health and Life Sciences, Glasgow Caledonian University

Thomas M Caparrotta

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Joseph Mellor

Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh

Anita Jeyam

nstitute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Joseph E O’Reilly

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Sarah Wild

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Sara Hatam

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Andreas Höhn

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Marco Colombo

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Chris Robertson

University of Strathclyde - Department of Mathematics & Statistics

Nazir I. Lone

University of Edinburgh - Asthma UK Centre for Applied Research

Janet Murray

Health Protection Scotland (Public Health Scotland)

Elaine Butterly

Institute of Health and Wellbeing, University of Glasgow

John Petrie

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Brian Kennon

Queen Elizabeth University Hospital

Rory McCrimmon

Division of Molecular and Clinical Medicine, University of Dundee

Robert Lindsay

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Ewan Pearson

Division of Molecular and Clinical Medicine, University of Dundee

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

John McKnight

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Ashirwad Philip Samuel

GD Goenka University

Andrew Collier

School of Health and Life Sciences, Glasgow Caledonian University

Jim McMenamin

Public Health Scotland; Government of the United Kingdom - Public Health Scotland

Alison Smith-Palmer

Health Protection Scotland (Public Health Scotland)

David Goldberg

Health Protection Scotland (Public Health Scotland)

Paul M McKeigue

Health Protection Scotland (Public Health Scotland)

Helen M Colhoun

Health Protection Scotland

Public Health Scotland COVID-19 Health Protection Study Group

Independent

Scottish Diabetes Research Network Epidemiology Group

Independent

More...

Abstract

Background: The risks of, and risk factors for, COVID-19 disease associated with diabetes are poorly quantified.

Methods: We identified as cases all those in Scotland with a positive SARS-CoV-2 nucleic acid test in the national laboratory database and anyone else with a death certificate mentioning COVID-19. Seven controls matched for age, sex and general practice were selected per case. Data were linked to the national diabetes register, hospitalisation and critical care unit (CCU) databases. Analyses focused on those with COVID-19 requiring critical care or dying. Analyses were by conditional and unconditional logistic regression.

Findings: 0.3% (n=845) of those with diabetes had developed severe or fatal COVID-19, representing rate ratios of 3.86 (2.74, 5.45) in type 1 and 1.69 (1.56, 1.84) in type 2 diabetes. Rates were almost threefold in the most versus least socioeconomically deprived quintiles of the population. Most (77%) cases had another recognised co-morbidity such as heart or lung disease (OR 2.6). Diabetes specific factors associated with increased risk included; HbA1c odds ratio (OR) >85 mmol/mol versus <53: 1.96(1.55,2.48);p-value <0.001, prior diabetic ketoacidosis: OR 2.44(1.41,4.20);p-value 0.001 and hypoglycaemia hospitalisations: OR 3.28(2.41,4.46);p-value <0.001. Chronic retinal and renal complications were also associated with increased risk. A cross-validated predictive model of severe or fatal disease had a C-statistic of 0.83. 

Interpretations: Relative risks of severe or fatal COVID-19 are substantially elevated in both types of diabetes. Risk scores based on prior clinical history should be useful for identifying those with diabetes needing tailored protective measures.

Funding Statement: There was no specific funder for this study.

Declaration of Interests: The authors declare no conflicts of interest.

Ethics Approval Statement: This research was conducted with approval from the Public Benefit Privacy Protection Panel (PBPP ref. 1617- 0147), originally set up under PAC 33/11, with approval from the Scotland A Research Ethics Committee (ref. 11/AL/0225). All datasets were de-identified before analysis.

Suggested Citation

McGurnaghan, Stuart J and Weir, Amanda and Bishop, Jen and Kennedy, Sharon and Blackbourn, Luke AK and Hutchinson, Sharon and Caparrotta, Thomas M and Mellor, Joseph and Jeyam, Anita and O’Reilly, Joseph E and Wild, Sarah and Hatam, Sara and Höhn, Andreas and Colombo, Marco and Robertson, Chris and Lone, Nazir I. and Murray, Janet and Butterly, Elaine and Petrie, John and Kennon, Brian and McCrimmon, Rory and Lindsay, Robert and Pearson, Ewan and Sattar, Naveed and McKnight, John and Samuel, Ashirwad Philip and Collier, Andrew and McMenamin, Jim and Smith-Palmer, Alison and Goldberg, David and McKeigue, Paul M and Colhoun, Helen M and Group, Public Health Scotland COVID-19 Health Protection Study and Group, Scottish Diabetes Research Network Epidemiology, COVID-19 Disease in People with Diabetes in Scotland: Incidence, Severity and Risk Stratification Using Matched Case-Control and Prospective Cohort Studies (6/29/2020). The Lancet Diabetes & Endocrinology, Volume 9, ISSUE 2, P82-93, February 01, 2021, https://doi.org/10.1016/S2213-8587(20)30405-8, Available at SSRN: https://ssrn.com/abstract=3640560 or http://dx.doi.org/10.2139/ssrn.3640560

Stuart J McGurnaghan (Contact Author)

ealth Protection Scotland (Public Health Scotland)

Amanda Weir

ealth Protection Scotland (Public Health Scotland)

Jen Bishop

Health Protection Scotland (Public Health Scotland)

Sharon Kennedy

Health Protection Scotland (Public Health Scotland) ( email )

Luke AK Blackbourn

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Sharon Hutchinson

School of Health and Life Sciences, Glasgow Caledonian University

Thomas M Caparrotta

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Joseph Mellor

Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh

Anita Jeyam

nstitute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Joseph E O’Reilly

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Sarah Wild

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Sara Hatam

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Andreas Höhn

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Marco Colombo

Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh

Chris Robertson

University of Strathclyde - Department of Mathematics & Statistics

26 Richmond Street
Glasgow G1 1XH
United Kingdom

Nazir I. Lone

University of Edinburgh - Asthma UK Centre for Applied Research

Edinburgh
United Kingdom

Janet Murray

Health Protection Scotland (Public Health Scotland)

Elaine Butterly

Institute of Health and Wellbeing, University of Glasgow

John Petrie

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Brian Kennon

Queen Elizabeth University Hospital

Rory McCrimmon

Division of Molecular and Clinical Medicine, University of Dundee

Robert Lindsay

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Ewan Pearson

Division of Molecular and Clinical Medicine, University of Dundee

Naveed Sattar

University of Glasgow - Institute of Cardiovascular and Medical Sciences

Glasgow, Scotland
United Kingdom

John McKnight

Institute of Cardiovascular and Medical Sciences, University of Glasgow

Ashirwad Philip Samuel

GD Goenka University ( email )

Sohna Gurgaon Road
SOHNA GURGAON ROAD
Sohna, HI Haryana 122001
India

Andrew Collier

School of Health and Life Sciences, Glasgow Caledonian University

Jim McMenamin

Public Health Scotland

Glasgow, Scotland
United Kingdom

Government of the United Kingdom - Public Health Scotland

Alison Smith-Palmer

Health Protection Scotland (Public Health Scotland)

David Goldberg

Health Protection Scotland (Public Health Scotland)

Paul M McKeigue

Health Protection Scotland (Public Health Scotland)

Helen M Colhoun

Health Protection Scotland

Glasgow, Scotland
United Kingdom