The aim of this retrospective audit, conducted by the Association of British Clinical Endocrinologists, was to identify the risk factors associated with severe COVID-19 outcomes (admission to intensive care or death) in people with type 1 diabetes who were hospitalised with COVID-19 infection between March and October 2020. Data from 194 inpatients, the largest published cohort of people with type 1 diabetes and contemporaneous admission data to date, were analysed.
Within the cohort, 55% were men and 70% were of white ethnicity, the mean age was 62 years and mean BMI 28.3 kg/m2. The mean HbA1c was 76 mmol/mol (9.1%); however, half of the cohort had an HbA1c under 58 mmol/mol (7.5%). Overall, 56% had a microvascular diabetes complication and 39% a macrovascular complication.
A total of 68 patients (35%) met the primary outcome (admission to intensive care and/or death). Fifty-three patients (27%) died, most within 1 week of admission; however, two deaths occurred after 7 weeks. There was a clear age gradient in mortality risk; only five of 67 patients aged <55 years died, of whom all had a microvascular and/or macrovascular complication. BMI, serum creatinine level and the presence of microvascular disease were positively associated with severe disease after adjustment for age.
The authors conclude that the risk of severe COVID-19 is reassuringly low in people with type 1 diabetes who are under 55 years of age and who do not have micro- or macrovascular complications.
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Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024