Catherine E Barrett1,2, Joohyun Park3, Lyudmyla Kompaniyets2, James Baggs2, Yiling J Cheng4, Ping Zhang3, Giuseppina Imperatore3, Meda E Pavkov3. 1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA ohi6@cdc.gov. 2. COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA. 3. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 4. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
OBJECTIVE: To assess whether risk of severe outcomes among patients with type 1 diabetes mellitus (T1DM) hospitalized for coronavirus disease 2019 (COVID-19) differs from that of patients without diabetes or with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: Using the Premier Healthcare Database Special COVID-19 Release records of patients discharged after COVID-19 hospitalization from U.S. hospitals from March to November 2020 (N = 269,674 after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without diabetes or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. RESULTS: Compared with patients without diabetes, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD 0.21, 95% CI 0.19-0.24; RR 1.49, 95% CI 1.43-1.56) and a 5% higher absolute risk of mortality (RD 0.05, 95% CI 0.03-0.07; RR 1.40, 95% CI 1.24-1.57), with adjustment for age, sex, and race or ethnicity. Compared with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD 0.09, 95% CI 0.07-0.12; RR 1.17, 95% CI 1.12-1.22), but no difference in mortality (RD 0.00, 95% CI -0.02 to 0.02; RR 1.00, 95% CI 0.89-1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD 0.01, 95% CI -0.01 to 0.03) and had lower mortality (RD -0.03, 95% CI -0.05 to -0.01) in comparisons with patients with T2DM. CONCLUSIONS: Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without diabetes. Higher risk of ICU/MV in patients with T1DM than in patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to diabetes management and the prevention of COVID-19.
OBJECTIVE: To assess whether risk of severe outcomes among patients with type 1 diabetes mellitus (T1DM) hospitalized for coronavirus disease 2019 (COVID-19) differs from that of patients without diabetes or with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: Using the Premier Healthcare Database Special COVID-19 Release records of patients discharged after COVID-19 hospitalization from U.S. hospitals from March to November 2020 (N = 269,674 after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without diabetes or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. RESULTS: Compared with patients without diabetes, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD 0.21, 95% CI 0.19-0.24; RR 1.49, 95% CI 1.43-1.56) and a 5% higher absolute risk of mortality (RD 0.05, 95% CI 0.03-0.07; RR 1.40, 95% CI 1.24-1.57), with adjustment for age, sex, and race or ethnicity. Compared with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD 0.09, 95% CI 0.07-0.12; RR 1.17, 95% CI 1.12-1.22), but no difference in mortality (RD 0.00, 95% CI -0.02 to 0.02; RR 1.00, 95% CI 0.89-1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD 0.01, 95% CI -0.01 to 0.03) and had lower mortality (RD -0.03, 95% CI -0.05 to -0.01) in comparisons with patients with T2DM. CONCLUSIONS: Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without diabetes. Higher risk of ICU/MV in patients with T1DM than in patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to diabetes management and the prevention of COVID-19.
Authors: Roman Vangoitsenhoven; Pieter-Jan Martens; Falco van Nes; Carolien Moyson; Frank Nobels; Paul Van Crombrugge; Katrien Wierckx; Inge van Pottelbergh; Liesbeth Van Huffel; Pieter Gillard; Chantal Mathieu Journal: Diabetes Care Date: 2020-07-09 Impact factor: 19.112
Authors: Sameer S Kadri; Jake Gundrum; Sarah Warner; Zhun Cao; Ahmed Babiker; Michael Klompas; Ning Rosenthal Journal: JAMA Date: 2020-12-22 Impact factor: 56.272
Authors: Victor W Zhong; Jihad S Obeid; Jean B Craig; Emily R Pfaff; Joan Thomas; Lindsay M Jaacks; Daniel P Beavers; Timothy S Carey; Jean M Lawrence; Dana Dabelea; Richard F Hamman; Deborah A Bowlby; Catherine Pihoker; Sharon H Saydah; Elizabeth J Mayer-Davis Journal: J Am Med Inform Assoc Date: 2016-04-23 Impact factor: 4.497
Authors: Victor W Zhong; Emily R Pfaff; Daniel P Beavers; Joan Thomas; Lindsay M Jaacks; Deborah A Bowlby; Timothy S Carey; Jean M Lawrence; Dana Dabelea; Richard F Hamman; Catherine Pihoker; Sharon H Saydah; Elizabeth J Mayer-Davis Journal: Pediatr Diabetes Date: 2014-06-09 Impact factor: 4.866
Authors: Bruce Bode; Valerie Garrett; Jordan Messler; Raymie McFarland; Jennifer Crowe; Robby Booth; David C Klonoff Journal: J Diabetes Sci Technol Date: 2020-05-09
Authors: Stuart J McGurnaghan; Amanda Weir; Jen Bishop; Sharon Kennedy; Luke A K Blackbourn; David A McAllister; Sharon Hutchinson; Thomas M Caparrotta; Joseph Mellor; Anita Jeyam; Joseph E O'Reilly; Sarah H Wild; Sara Hatam; Andreas Höhn; Marco Colombo; Chris Robertson; Nazir Lone; Janet Murray; Elaine Butterly; John Petrie; Brian Kennon; Rory McCrimmon; Robert Lindsay; Ewan Pearson; Naveed Sattar; John McKnight; Sam Philip; Andrew Collier; Jim McMenamin; Alison Smith-Palmer; David Goldberg; Paul M McKeigue; Helen M Colhoun Journal: Lancet Diabetes Endocrinol Date: 2020-12-23 Impact factor: 32.069
Authors: Michael Gröger; Melanie Hogg; Essam Abdelsalam; Sandra Kress; Andrea Hoffmann; Bettina Stahl; Enrico Calzia; Ulrich Wachter; Josef A Vogt; Rui Wang; Tamara Merz; Peter Radermacher; Oscar McCook Journal: Front Med (Lausanne) Date: 2022-04-29
Authors: Andrew R Lavik; Osagie Ebekozien; Nudrat Noor; G Todd Alonso; Sarit Polsky; Scott M Blackman; Justin Chen; Sarah D Corathers; Carla Demeterco-Berggren; Mary Pat Gallagher; Margaret Greenfield; Ashley Garrity; Saketh Rompicherla; Robert Rapaport; Nana-Hawa Yayah Jones Journal: J Clin Endocrinol Metab Date: 2022-06-16 Impact factor: 6.134
Authors: Denise L Faustman; Amanda Lee; Emma R Hostetter; Anna Aristarkhova; Nathan C Ng; Gabriella F Shpilsky; Lisa Tran; Grace Wolfe; Hiroyuki Takahashi; Hans F Dias; Joan Braley; Hui Zheng; David A Schoenfeld; Willem M Kühtreiber Journal: Cell Rep Med Date: 2022-08-15