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Covid-19 Primary Care Resources


Covid-19 risk for patients with diabetes


diabetes


Current evidence on Covid-19 related mortality in Type 1 and Type 2 diabetes

This information is sourced from NHS England, and the Primary Care Diabetes Society (PCDS):

Key headlines for Primary care from the PCDS February 2021:

  • A third of all Covid-19-related deaths in the first wave were in people with diabetes
  • If people with diabetes develop symptomatic Covid-19 requiring hospital admission, the risk of dying is increased 2–3-fold compared to people without diabetes
  • Amongst people with diabetes admitted to hospital, poor glucose control prior to catching Covid-19 increases the risk of dying, as do high BMI, CKD, heart failure and previous stroke
  • People of black, Asian and other minority ethnic background and those from more deprived areas are at greater risk
  • Covid-19 induces a combination of both severe insulin resistance and insulin deficiency making the management of people with Covid-19 and diabetes more complex
  • Some people with diabetes may be discharged from hospital on higher doses or additional glucose-lowering therapies, including insulin, that may need adjustment in subsequent days or weeks

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On 20th May 2020 NHSE published two cohort studies on Type 1 and Type 2 diabetes and Covid-19 related mortality in England

The first of these studies examined hospital deaths related to Covid-19 in England over a 10-week period up to 11 May 2020:

  • Of the 23 804 Covid-19 related deaths, a disproportionate number had diabetes : 31.4% had type 2 diabetes and 1.5% had type 1 diabetes
  • People with type 1 diabetes were 3.5 times more likely to die in hospital with Covid-19 than those without diabetes, and people with type 2 diabetes were just over twice as likely

The second cohort study, focussed just on people with diabetes and looked at risk factors for Covid 19 related mortality. The study found:

  • Poor glycaemic control, poor renal function and higher BMI were all associated with higher Covid-19 related mortality
  • In those with type 2 diabetes, risk of death was 1.23X higher in diabetics with an HbA1c of 59–74 (7.5–8.9%), and 1.62X higher for those with an HbA1c of ≥86 (≥10.0%) [compared with an HbA1c of 48–53 (6.5–7.0%)]
  • In those with type 1 diabetes, poor glycaemic control [ HbA1c ≥86 (≥10.0%)] was associated with a  2X increased risk of death compared with good glycaemic control [HbA1c of 48–53 (6.5–7.0%)]
  • In those with type 2 diabetes, a high BMI [≥40] was associated with a 1.5 x increased risk of death, and a low BMI [<20] was associate 2.3X increased risk of death, when compare to a BMI of 25–29.9
  • Impaired renal function was also associated with an increased risk of Covid-19-related mortality. In those with type 2 diabetes an eGFR of 30–44 (stage 3b CKD), was associated with 1.75X increasd risk,  and an eGFR of <15 (stage 5 CKD) was associated with 5X increased risk of mortality compared to those with eGFR >60

Written by Dr Poppy Freeman