TY - JOUR
T1 - Risks of and risk factors for COVID-19 disease in people with diabetes
T2 - a cohort study of the total population of Scotland
AU - McGurnaghan, Stuart J.
AU - Weir, Amanda
AU - Bishop, Jen
AU - Kennedy, Sharon
AU - Blackbourn, Luke A. K.
AU - McAllister, David A.
AU - Hutchinson, Sharon
AU - Caparrotta, Thomas M.
AU - Mellor, Joseph
AU - Jeyam, Anita
AU - O'Reilly, Joseph E.
AU - Wild, Sarah H.
AU - Hatam, Sara
AU - Höhn, Andreas
AU - Colombo, Marco
AU - Robertson, Chris
AU - Lone, Nazir
AU - Murray, Janet
AU - Butterly, Elaine
AU - Petrie, John
AU - Kennon, Brian
AU - McCrimmon, Rory
AU - Lindsay, Robert
AU - Pearson, Ewan
AU - Sattar, Naveed
AU - McKnight, John
AU - Philip, Sam
AU - Collier, Andrew
AU - McMenamin, Jim
AU - Smith-Palmer, Alison
AU - Goldberg, David
AU - McKeigue, Paul M.
AU - Colhoun, Helen M.
N1 - Funding Information:
SHu reports grants from Health Protection Scotland during the conduct of the study. TMC reports grants from Diabetes UK (18/0005786). SHW reports attendance at meetings of the Scottish Study Group for Diabetes in the Young supported by Novo Nordisk and honorarium from attendance at an advisory board paid to research funds from Gilead. CR reports grants from Public Health Scotland and UK Research and Innovation; and being a member of the Chief Medical Officer of Scotland Scientific Advisory Group for COVID-19, a member of the Scientific Pandemic Influenza Group on Modelling, a subgroup of the UK Scientific Advisory Group for Epidemics, and a member of the Medicines and Healthcare products Regulatory Agency Advisory Group for Vaccine Safety. JP reports personal fees and non-financial support from Merck, personal fees from Novo Nordisk, Biocon, and Boehringer-Ingelheim, grants from Janssen, and non-financial support from Astra Zeneca. RM reports personal fees from Novo Nordisk and Sanofi Aventis. NS reports personal fees from Amgen, Eli Lilly, Novo Nordisk, Pfizer, Sanofi, and AstraZeneca, and grants and personal fees from Boehringer Ingelheim. JMcK reports personal fees from NAPP pharmaceuticals, insitutional fees for trial participation from Novo Nordisk, Eli Lilly, Boehringer Ingelheim, Medimmune, and GlaxoSmithKline. HMC reports grants and personal fees from Eli Lilly and Novo Nordisk, grants from AstraZeneca, Regeneron, and Pfizer, institutional fees from Novartis and Sanofi Aventis, and being a shareholder with Roche Pharmaceuticals. All other authors declare no competing interests.
Funding Information:
All datasets were deidentified before analysis. We thank all staff in critical care units who submitted data to the SICSAG database, the Scottish Morbidity Record Data Team, the staff of the National Register of Scotland, the Public Health Scotland Terminology Services, the Public Health Scotland COVID-19 Laboratory and Testing cell, the NHS Scotland Diagnostic Virology Laboratories, and Nicola Rowan (Public Health Scotland) for coordinating this collaboration.
Publisher Copyright:
© 2021 Elsevier Ltd
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Background: We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes.Methods: In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation.Findings: Of the total Scottish population on March 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5·8%), 1082 (0·3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89·8%) were aged 60 years or older. In the population without diabetes, 4081 (0·1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1·395 (95% CI 1·304–1·494; p<0·0001, compared with the risk in those without diabetes. The OR was 2·396 (1·815–3·163; p<0·0001) in type 1 diabetes and 1·369 (1·276–1·468; p<0·0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more anti-diabetic and other medication (all p<0·0001), and have been a smoker (p=0·0011). The cross-validated predictive model of fatal or critical care unit-treated COVID-19 in people with diabetes had a C-statistic of 0·85 (0·83–0·86).Interpretation: Overall risks of fatal or critical care unit-treated COVID-19 were substantially elevated in those with type 1 and type 2 diabetes compared with the background population. The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history. Funding: None.
AB - Background: We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes.Methods: In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation.Findings: Of the total Scottish population on March 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5·8%), 1082 (0·3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89·8%) were aged 60 years or older. In the population without diabetes, 4081 (0·1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1·395 (95% CI 1·304–1·494; p<0·0001, compared with the risk in those without diabetes. The OR was 2·396 (1·815–3·163; p<0·0001) in type 1 diabetes and 1·369 (1·276–1·468; p<0·0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more anti-diabetic and other medication (all p<0·0001), and have been a smoker (p=0·0011). The cross-validated predictive model of fatal or critical care unit-treated COVID-19 in people with diabetes had a C-statistic of 0·85 (0·83–0·86).Interpretation: Overall risks of fatal or critical care unit-treated COVID-19 were substantially elevated in those with type 1 and type 2 diabetes compared with the background population. The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history. Funding: None.
UR - http://www.scopus.com/inward/record.url?scp=85099198665&partnerID=8YFLogxK
U2 - 10.1016/S2213-8587(20)30405-8
DO - 10.1016/S2213-8587(20)30405-8
M3 - Article
C2 - 33357491
SN - 2213-8587
VL - 9
SP - 82
EP - 93
JO - The Lancet: Diabetes and Endocrinology
JF - The Lancet: Diabetes and Endocrinology
IS - 2
ER -