Marc Diedisheim1,2, Etienne Dancoisne3,4, Jean-François Gautier1,5, Etienne Larger2, Emmanuel Cosson6,7, Bruno Fève8,9,10, Philippe Chanson11,12, Sébastien Czernichow13,14, Sopio Tatulashvili6,7, Marie-Laure Raffin-Sanson15,16, Kankoé Sallah4, Muriel Bourgeon17, Christiane Ajzenberg18, Agnès Hartemann19, Christel Daniel3,20, Thomas Moreau21, Ronan Roussel1,22, Louis Potier1,22. 1. Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, 75006 Paris, France. 2. Hôpital Cochin, APHP, Diabetology Department, 75014 Paris, France. 3. Assistance Publique-Hôpitaux de Paris, DSI WIND, Web Innovation Données, 75012 Paris, France. 4. Hôpital Bichat - Claude-Bernard, APHP, URC PNVS, CIC-EC 1425, INSERM, 75018 Paris, France. 5. GH Lariboisiere Fernand-Widal, APHP, Department of Diabetes and Endocrinology, 75010 Paris, France. 6. Hospital Avicenne, APHP, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bobigny, France. 7. Université Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE, Unité de Recherche Epidémiologique Nutritionnelle, 93000 Bobigny, France. 8. Hôpital Saint-Antoine, APHP, Department of Endocrinology-Diabetology, 75012 Paris, France. 9. Institut Hospitalo-Universitaire ICAN, 75013 Paris, France. 10. Sorbonne Université, INSERM, UMR_S938, CRMR PRISIS, 75012 Paris, France. 11. Hôpital Bicêtre, APHP, Service d'Endocrinologie et des Maladies de la Reproduction, 94270 Le Kremlin-Bicetre, France. 12. Université Paris-Saclay, INSERM, Physiologie et Physiopathologie Endocriniennes, 94270 Le Kremlin-Bicetre, France. 13. Hôpital Européen Georges Pompidou, APHP, Service de Nutrition, Centre Spécialisé Obésité, 75015 Paris, France. 14. Université de Paris, INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), 75015 Paris, France. 15. Hospital Ambroise Paré, APHP, Service d'Endocrinologie Diabétologie et Nutrition, 92100 Boulogne-Billancourt, France. 16. Université de Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France. 17. Hôpital Antoine-Béclère, APHP, Service de Médecine Interne, 92140 Clamart, France. 18. Hôpital Henri Mondor, APHP, Service de Médecine Interne, 94000 Creteil, France. 19. Hôpital Pitié Salpêtrière, APHP, Diabetology Department, 75013 Paris, France. 20. Sorbonne Université, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S 1142, 75006 Paris, France. 21. Université Paris-Saclay, INRIA, CEA, 91120 Palaiseau, France. 22. Hôpital Bichat - Claude-Bernard, APHP, Department of Diabetology, 75018 Paris, France.
Abstract
CONTEXT: Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE: To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS: We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S): The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS: Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS: Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.
CONTEXT: Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE: To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS: We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S): The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS: Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS: Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.