A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection

Abstract

Aims/hypothesis: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK.

Methods: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs.

Results: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m² and last recorded HbA_1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age.

Conclusions/interpretation: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.

Keywords: COVID-19; Inpatients; Mortality; National audit; Type 1 diabetes.

Fig. 1

Forest plot of the ORs (95% CIs) for the association between severe COVID-19 (death or AICU admission) and clinical variables after adjusting for age. The comparison groups (sample size) are: male vs female (n = 195); non-white vs white (n = 156); BMI ≥30 kg/m² vs <25 kg/m² (n = 121); BMI 25–29.9 kg/m² vs <25 kg/m² (n = 121); blood glucose ≥20 mmol/l vs <10 mmol/l (n = 122); blood glucose 10–19.9 mmol/l vs <10 mmol/l (n = 122); HbA1c ≥75 mmol/mol (≥9.0%) vs <75 mmol/mol (<9.0%) (n = 161); serum creatinine <74 μmol/l vs 74–107 μmol/l (n = 137); serum creatinine >107 μmol/l vs 74–107 μmol/l (n = 137); DKA vs no DKA (n = 171); diabetic microvascular disease vs no diabetic microvascular disease (n = 176); diabetic macrovascular disease vs no diabetic macrovascular disease (n = 156); hypertension vs no hypertension (n = 167); dementia vs no dementia (n = 160); asthma vs no asthma (n = 150), chronic obstructive pulmonary disease (COPD) vs no COPD (n = 149); malignant neoplasm vs no malignant neoplasm (n = 154); smoker vs non-smoker (n = 100); metformin vs no metformin (n = 161). The base used for logarithmic transformations on the x-axis is log₁₀