Vol 73, No 1 (2022)
Original paper
Published online: 2022-01-31

open access

Page views 6127
Article views/downloads 702
Get Citation

Connect on Social Media

Connect on Social Media

Higher rate of COVID-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study

Ibrahim Demirci1, Cem Haymana1, Ilker Tasci2, Ilhan Satman34, Aysegul Atmaca5, Mustafa Sahin6, Naim Ata7, Ugur Unluturk8, Erman Cakal9, Selcuk Dagdelen8, Ibrahim Sahin10, Osman Celik11, Derun Ertugrul12, Tevfik Demir13, Rifat Emral6, Murat Caglayan14, Serpil Salman15, Suayip Birinci16, Alper Sonmez17
Pubmed: 35119089
Endokrynol Pol 2022;73(1):87-95.

Abstract

Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM.

Material and methods: A nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n = 149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n = 163), T2DM (n = 33,478) and those without diabetes (n = 115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation, and mortality.

Results: The patients with T1DM had higher mortality than the age- and gender-matched patients with T2DM (n = 489) and those without diabetes (n = 489) (p < 0.001). After further adjustment for the HbA1c, and microvascular and macrovascular complications, the odds of mortality (OR: 3.35, 95% CI: 1.41–7.96, p = 0.006) and ICU admission and/or mechanical ventilation (OR: 2.95, 95% CI: 1.28–6.77, p = 0.011) were significantly higher in patients with T1DM compared to those with T2DM. Older age (OR: 1.06, 95% CI: 1.01–1.12, p = 0.028) and lymphopaenia (OR: 5.13, 95% CI: 1.04–25.5, p = 0.045) were independently associated with mortality in patients with T1DM.

Conclusions: Patients with T1DM had worse prognosis of COVID-19 compared to T2DM patients or those without diabetes. These cases should be cared for diligently until more data become available about the causes of increased COVID-19 mortality in T1DM.

Article available in PDF format

View PDF Download PDF file

References

  1. Muller LM, Gorter KJ, Hak E, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005; 41(3): 281–288.
  2. Allard R, Leclerc P, Tremblay C, et al. Diabetes and the severity of pandemic influenza A (H1N1) infection. Diabetes Care. 2010; 33(7): 1491–1493.
  3. Sanyaolu A, Okorie C, Marinkovic A, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020 [Epub ahead of print]: 1–8.
  4. Fathi M, Vakili K, Sayehmiri F, et al. The prognostic value of comorbidity for the severity of COVID-19: A systematic review and meta-analysis study. PLoS One. 2021; 16(2): e0246190.
  5. Sun Y, Guan X, Jia L, et al. Independent and combined effects of hypertension and diabetes on clinical outcomes in patients with COVID-19: A retrospective cohort study of Huoshen Mountain Hospital and Guanggu Fangcang Shelter Hospital. J Clin Hypertens (Greenwich). 2021; 23(2): 218–231.
  6. Dennis JM, Mateen BA, Sonabend R, et al. Type 2 Diabetes and COVID-19-Related Mortality in the Critical Care Setting: A National Cohort Study in England, March-July 2020. Diabetes Care. 2021; 44(1): 50–57.
  7. Sonmez A, Demirci I, Haymana C, et al. Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes. 2021; 13(7): 585–595.
  8. Carrasco-Sánchez FJ, López-Carmona MªD, Martínez-Marcos FJ, et al. SEMI-COVID-19 Network. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med. 2021; 53(1): 103–116.
  9. Wang D, Hu Bo, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061–1069.
  10. Alguwaihes AM, Al-Sofiani ME, Megdad M, et al. Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study. Cardiovasc Diabetol. 2020; 19(1): 205.
  11. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020; 14(4): 395–403.
  12. Cariou B, Pichelin M, Goronflot T, et al. CORONADO investigators, CORONADO investigators, CORONADO investigators, CORONADO investigators. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020; 63(8): 1500–1515.
  13. Agarwal S, Schechter C, Southern W, et al. Preadmission Diabetes-Specific Risk Factors for Mortality in Hospitalized Patients With Diabetes and Coronavirus Disease 2019. Diabetes Care. 2020; 43(10): 2339–2344.
  14. Zhu L, She ZG, Cheng Xu, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020; 31(6): 1068–1077.e3.
  15. Fisher L, Polonsky W, Asuni A, et al. The early impact of the COVID-19 pandemic on adults with type 1 or type 2 diabetes: A national cohort study. J Diabetes Complications. 2020; 34(12): 107748.
  16. Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol. 2020; 8(10): 813–822.
  17. O'Malley G, Ebekozien O, Desimone M, et al. COVID-19 Hospitalization in Adults with Type 1 Diabetes: Results from the T1D Exchange Multicenter Surveillance Study. J Clin Endocrinol Metab. 2021; 106(2): e936–e942.
  18. Ebekozien OA, Noor N, Gallagher MP, et al. Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S. Diabetes Care. 2020; 43(8): e83–e85.
  19. Vamvini M, Lioutas VA, Middelbeek RJW. Characteristics and Diabetes Control in Adults With Type 1 Diabetes Admitted With COVID-19 Infection. Diabetes Care. 2020; 43(10): e120–e122.
  20. Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2020; 8(10): 823–833.
  21. Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604–612.
  22. Ruan Y, Ryder REJ, De P, et al. ABCD Covid-19 audit group. A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection. Diabetologia. 2021; 64(8): 1717–1724.
  23. Wargny M, Gourdy P, Ludwig L, et al. CORONADO investigators. Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study. Diabetes Care. 2020; 43(11): e174–e177.
  24. Pitocco D, Tartaglione L, Viti L, et al. Lack of type 1 diabetes involvement in SARS-COV-2 population: Only a particular coincidence? Diabetes Res Clin Pract. 2020; 164: 108220.
  25. Gregory JM, Slaughter JC, Duffus SH, et al. COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic's Impact in Type 1 and Type 2 Diabetes. Diabetes Care. 2021; 44(2): 526–532.
  26. Al Hayek AA, Robert AA, Alotaibi ZK, et al. Clinical characteristics of hospitalized and home isolated COVID-19 patients with type 1 diabetes. Diabetes Metab Syndr. 2020; 14(6): 1841–1845.
  27. Wang L, He W, Yu X, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020; 80(6): 639–645.
  28. Ho FK, Petermann-Rocha F, Gray SR, et al. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. PLoS One. 2020; 15(11): e0241824.
  29. Shahid Z, Kalayanamitra R, McClafferty B, et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc. 2020; 68(5): 926–929.
  30. Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care. 2020; 8: 36.
  31. Muñoz-Rodríguez JR, Gómez-Romero FJ, Pérez-Ortiz JM, et al. COVID-19 SESCAM Network. Characteristics and Risk Factors Associated With Mortality in a Multicenter Spanish Cohort of Patients With COVID-19 Pneumonia. Arch Bronconeumol. 2021; 57: 34–41.