A person with diabetes is at risk of developing severe Covid-19. At the same time, severe Covid-19 also adversely affects glycemic control and worsens hyperglycemia, which in turn affects the course of the infection, creating a vicious cycle. However, whether this risk is uniform across all ages is not clear.A retrospective observational cohort study was conducted to evaluate the impact of Covid-19 in 6314 patients with and without diabetes. The study also examined the difference in the impact a...
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Younger diabetic adults more at risk of severe COVID-19
Dr Sanjay Kalra, DM, Bharti Hospital, Karnal; Immediate Past President, Endocrine Society of India, 15 September 2021 #Multispeciality
A person with diabetes is at risk of developing severe Covid-19. At the same time, severe Covid-19 also adversely affects glycemic control and worsens hyperglycemia, which in turn affects the course of the infection, creating a vicious cycle. However, whether this risk is uniform across all ages is not clear.
A retrospective observational cohort study was conducted to evaluate the impact of Covid-19 in 6314 patients with and without diabetes. The study also examined the difference in the impact according to the age of the patients. These patients had been hospitalized between February and June 2020 and were followed up until the end of September in the same year. In-hospital mortality or intensive care unit (ICU) admission with orotracheal intubation within 90 days of first admission were the primary outcome measures.
Of the 6314 participants, 2459 (39%) were found to have diabetes. More men than women had diabetes (65% vs 54%, p < 0.001). Diabetic patients also had higher incidence of associated comorbidities: higher BMI (27.4 vs 25.3 kg/m2, p < 0.001), previous arterial hypertension (62% vs 43%, p < 0.001), dyslipidemia (21% vs 8%, p < 0.001), cardiovascular diseases (34% vs 19%, p < 0.001), heart failure (19% vs 15%, p < 0.001) and chronic kidney disease (26% vs 17%, p < 0.001).
The frequency of orotracheal intubation as well as mortality were higher in diabetic patients (39% vs 32%) and increased with age in those without diabetes, from 26% among patients younger than 50 years to 35% for those older than 80 years but reached a plateau after 70 years in those with diabetes.
A comparison of patients with and without diabetes showed that diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. The adjusted HR for the risk of primary outcome between groups decreased with age from 1.52 for patients younger than 50 years to 1.30 for patients aged 60 to 70 years, and was non-significant for persons aged 70 years and above. While mortality was higher in patients with diabetes (26%) than in those without diabetes (22%), adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81).
Based on these findings, the researchers concluded that diabetes is associated with severe Covid-19 particularly in persons younger than 70 years. The disease was especially more severe among those younger than 50 years compared to older adults.
Landstra CP, et al. COVID-19 and diabetes: understanding the interrelationship and risks for a severe course. Front Endocrinol (Lausanne). 2021 Jun 17;12:649525.
Diedisheim M, et al. Diabetes increases severe COVID-19 outcomes primarily in younger adults. J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3364-e3368.
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