The risk factors potentially influencing hospital admission in people with type 1 diabetes and type 2 diabetes, following SARS-CoV- 2 infection: A population level analysis

ABSTRACT

Introduction: People with diabetes are particularly at high risk of becoming seriously unwell after contracting covid-19 infection. We do not fully understand underlying factors contributing to such risk/their respective contributions to outcomes. Methods: This population-based study included people living in the Greater Manchester conurbation with a recorded diagnosis of type 1 diabetes and type 2 diabeetes +subsequent covid-19 infection. Each individual with type 1 diabetes (n = 862)/ type 2 diabetes (n = 13,225) was matched with 3 covid-19 infected non-diabetes controls. Results: For type 1 diabetes individuals, the hospital admission rate in the first 28 days after covid-19 positive test was 10%vs4.7% in age/gender-matched controls (relative risk [RR] 2.1). For type 2 diabetes individuals, the hospital admission rate in the first 28 days after a covid-19 positive test was 16.3%vs11.6% in age/gender-matched controls(RR 1.4). Average Townsend score was higher in type 2 diabetes (1.8) vs matched controls(0.4), with a higher proportion of type 2 diabetes people in the top 2 quintiles of greatest disadvantage(p < 0.001). Within the group of covid-19 infected type 1 diabetes affected individuals, factors influencing the likelihood of admission included;age/body mass index (BMI)/ hypertension/ HbA1c/low HDL-cholesterol/ lower estimated glomerular filtration rate(eGFR)/COPD/being of African/ mixed ethnicity. In covid-19 infected type 2 diabetes individuals, factors potentially related to a higher admission rate included;age/Townsend Index/co-morbidity with COPD/asthma and severe mental illness(SMI)+lower eGFR. Metformin prescription lowered the admission likelihood. Conclusion: In a UK population, we have confirmed significantly higher likelihood of admission in people with diabetes following covid-19 infection. Several factors mediate the increased likelihood of hospital admission including metformin. For type 2 diabetes, the majority of factors related to increased admission rate are common to the general population but more prevalent in type 2 diabetes.