Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: a nationwide retrospective cohort study

Rawshani, A. et al. (2021) Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: a nationwide retrospective cohort study. Lancet Regional Health - Europe, 4, 100105. (doi: 10.1016/j.lanepe.2021.100105) (PMID:33969336) (PMCID:PMC8086507)

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Background: Whether infection with SARS-CoV-2 leads to excess risk of requiring hospitalization or intensive care in persons with diabetes has not been reported, nor have risk factors in diabetes associated with increased risk for these outcomes. Methods: We included 44,639 and 411,976 adult patients with type 1 and type 2 diabetes alive on Jan 1, 2020, and compared them to controls matched for age, sex, and county of residence (n=204,919 and 1,948,900). Age- and sex-standardized rates for COVID-19 related hospitalizations, admissions to intensive care and death, were estimated and hazard ratios were calculated using Cox regression analyses. Findings: There were 10,486 hospitalizations and 1,416 admissions into intensive care. A total of 1,175 patients with diabetes and 1,820 matched controls died from COVID-19, of these 53•2% had been hospitalized and 10•7% had been in intensive care. Patients with type 2 diabetes, compared to controls, displayed an age- and sex-adjusted hazard ratio (HR) of 2•22, 95%CI 2•13-2•32) of being hospitalized for COVID-19, which decreased to HR 1•40, 95%CI 1•34-1•47) after further adjustment for sociodemographic factors, pharmacological treatment and comorbidities, had higher risk for admission to ICU due to COVID-19 (age- and sex-adjusted HR 2•49, 95%CI 2•22-2•79, decreasing to 1•42, 95%CI 1•25-1•62 after adjustment, and increased risk for death due to COVID-19 (age- and sex-adjusted HR 2•19, 95%CI 2•03-2•36, complete adjustment 1•50, 95%CI 1•39-1•63). Age- and sex-adjusted HR for COVID-19 hospitalization for type 1 diabetes was 2•10, 95%CI 1•72-2•57), decreasing to 1•25, 95%CI 0•3097-1•62) after adjustment• Patients with diabetes type 1 were twice as likely to require intensive care for COVID-19, however, not after adjustment (HR 1•49, 95%CI 0•75-2•92), and more likely to die (HR 2•90, 95% CI 1•6554-5•47) from COVID-19, but not independently of other factors (HR 1•38, 95% CI 0•64-2•99). Among patients with diabetes, elevated glycated hemoglobin levels were associated with higher risk for most outcomes. Interpretation: In this nationwide study, type 2 diabetes was independently associated with increased risk of hospitalization, admission to intensive care and death for COVID-19. There were few admissions into intensive care and deaths in type 1 diabetes, and although hazards were significantly raised for all three outcomes, there was no independent risk persisting after adjustment for confounding factors.

Item Type:Articles
Additional Information:This work was supported by grants from: the Swedish state under an agreement concerning research and education of doctors [ALFGBG-717211]; the Swedish Heart and Lung Foundation [2018-0366]; the Swedish Research Council [2013-05187, VRREG 2019-00193, 2020-05792].
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed
Authors: Rawshani, A., Kjölhede, E. A., Rawshani, A., Sattar, N., Eeg-Olofsson, K., Adiels, M., Ludvigsson, J., Lindh, M., Gisslén, M., Hagberg, E., Lappas, G., Eliasson, B., and Rosengren, A.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Lancet Regional Health - Europe
Publisher:Lancet Publishing Group
ISSN (Online):2666-7762
Published Online:30 April 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Lancet Regional Health - Europe 1: 100105
Publisher Policy:Reproduced under a Creative Commons License

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