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Disclosures: Gregory reports no relevant financial disclosures.
December 21, 2020
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Similar increased risk for severe COVID-19 illness found in type 1, type 2 diabetes

Source/Disclosures
Disclosures: Gregory reports no relevant financial disclosures.
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Individuals with type 1 diabetes and those with type 2 diabetes have similar increased risks for COVID-19 hospitalization and severe illness compared with those without diabetes, according to a study published in Diabetes Care.

Justin M. Gregory

“The take-home message from our prospective cohort study is that patients with type 1 diabetes infected with SARS-CoV-2 have a three- to fourfold higher risk of hospitalization and severe illness compared with patients who do not have diabetes, after adjustment for other risk factors, such as age, BMI, hypertension and others,” Justin M. Gregory, MD, MSCI, assistant professor of pediatrics in the division of pediatric endocrinology and diabetes at Vanderbilt University Medical Center, told Healio. “This excess risk is nearly the same as patients with type 2 diabetes.”

Adults with type 1 diabetes and type 2 diabetes had similar increased risk for COVID-19 hospitalization compared with those with no diabetes.

Gregory and colleagues conducted a prospective cohort study on patients in the Vanderbilt University Medical Center health system who tested positive for COVID-19 from March 17 to Aug. 7. Data were compiled from the medical center’s Epic Clarity data warehouse. Individuals were categorized as having type 1 or type 2 diabetes based on problem list diagnosis. To quantify COVID-19 severity, data were gathered on hospitalizations, ICU admission, endotracheal intubation and mechanical ventilation, and death within 14 days of a positive test result.

Similar risks in type 1, type 2 diabetes

Of 69,701 individuals tested for COVID-19 during the study period, 6,451 were confirmed positive. Of COVID-19-positive individuals, 6,138 did not have diabetes, 40 had type 1 diabetes and 273 had type 2 diabetes. Individuals with type 1 diabetes were about three times more likely to be hospitalized than those without diabetes (22.5% vs. 7.1%; P < .001) whereas those in the type 2 diabetes group had a hospitalization rate nearly twice as high as the type 1 diabetes cohort (44.3% vs. 22.5%; P = .009). There were no deaths in the type 1 diabetes group, whereas 4.8% with type 2 diabetes and 0.5% of individuals without diabetes died.

After adjusting for age, race, sex, hypertension, smoking and BMI, individuals with type 1 diabetes (adjusted OR = 3.9; 95% CI, 1.75-8.69) and type 2 diabetes (aOR = 3.36; 95% CI, 2.49-4.55) were more likely to be hospitalized with COVID-19 complications than those without diabetes. Both the type 1 diabetes (aOR = 3.35; 95% CI, 1.53-7.33) and type 2 diabetes (aOR = 3.42; 95% CI, 2.55-4.58) groups had similar increased risk for worsening illness severity. Those with type 2 diabetes also had an increased risk for death compared with individuals without diabetes (aOR = 3.21; 95% CI, 1.54-6.7).

“When we designed the study, we hypothesized that patients with type 1 diabetes were more likely to have greater illness severity from COVID-19 than people without diabetes but would have less likelihood of having severe illness than patients with type 2 diabetes,” Gregory said. “Instead, our analysis shows that patients with type 1 and type 2 diabetes have nearly the same level of increased risk for hospitalization and greater illness severity.”

Clinical factors, social determinants

Researchers also conducted a detailed chart review of 37 individuals in the type 1 diabetes cohort. Fifteen of the 37 also agreed to participate in a telephone survey to answer questions about their medical history and social determinants of health. Of the 37 participants in the chart review, 76% did not require hospitalization, 14% were hospitalized without respiratory support or ICU admission, 3% were hospitalized with low-acuity respiratory support, 5% were admitted to the ICU and 3% required endotracheal intubation and mechanical ventilation. Clinical factors associated with worse COVID-19 severity included a previous diagnosis of hypertension, a higher HbA1c, taking any antihypertensive medication other than an ACE inhibitor or angiotensin receptor blocker, having at least one diabetic ketoacidosis admission in the past year, and not using continuous glucose monitoring.

Of Black individuals who participated in the survey, 71% were hospitalized vs. 11% for white participants. Only 8% of those with private insurance were hospitalized, whereas 60% of those with public insurance only and 67% with no insurance were hospitalized. There was a 9% hospitalization rate for CGM users vs. 47% for those using a blood glucose monitor. Only 6% of individuals using an insulin pump were hospitalized vs. 33% of individuals using multiple daily injections.

Gregory said the findings of the research show individuals with type 1 diabetes have a similar risk for poor health outcomes as those with type 2 diabetes and certain subgroups, such as Black individuals and those with no insurance, have an even greater risk for severe illness.

“Our study provides important evidence to healthy policy leaders indicating the need to prioritize immunization for people with type 1 diabetes alongside others with high-risk medical conditions like type 2 diabetes,” Gregory said.

For more information:

Justin M. Gregory, MD, MSCI, can be reached at justin.m.gregory.1@vumc.org.