Risk of death in people with type 2 diabetes following SARS-CoV- 2 infection: A population level analysis of potential risk factors

ABSTRACT

Introduction: In this study we set out to determine the relative likelihood of death following covid-19 infection in people with type 2 diabetes when compared to those without type 2 diabetes. Methods: Analysis of digital health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of type 2 diabetes and subsequent covid-19 confirmed infection. Each individual with type 2 diabetes (n = 13,807) was matched with three covid-19 infected non-diabetes controls (n = 39583). Results: For type 2 diabetes individuals, their mortality rate after a covid-19 positive test was 7.7% vs 6.0% in matched controls;the relative risk (RR) of death was 1.28. From univariate analysis performed within type 2 diabetes individuals, likelihood of death following covid-19 recorded infection was lower in people taking metformin, sodium glucose cotransporter-inhibitor 2(SGLT-2i) or glucagon-like peptide-1( GLP-1) agonist. A lower estimated glomerular filtration rate (eGFR) was associated with a higher mortality rate, as was hypertension history. Likelihood of death following covid-19 infection was also higher in those people with diagnosis of COPD/severe enduring mental illness, and in people taking aspirin/ clopidogrel/insulin. Smoking in people with type 2 diabetes significantly increased mortality rate. In combined analysis of type 2 diabetes patients/controls, multiple regression modelling indicated that factors independently relating to higher likelihood of death (accounting for 26% of variance) were type 2 diabetes/age/ malegender/social deprivation (higher Townsend index). Conclusion: Following confirmed infection with covid- 19 a number of factors are associated with mortality in type 2 diabetes individuals. Prescription of metformin, SGLT-2is or GLP-1 agonists + non-smoking status associated with reduced risk of death for people with type 2 diabetes. Age/male sex/social disadvantage associated with an increased risk of death.