People with type 2 diabetes as young as 40 face a disproportionately increased risk of dying from COVID-19 infection, suggesting a British analysis of three large-scale data sets highlighting the need to prioritize vaccination in younger groups of vulnerable patients.
Research it published February 8 in the journal Diabetology.
Most European countries have prioritized COVID-19 vaccination for people with type 2 diabetes, but usually only age 50 and over. However, data from the current study suggest that this age limit should be lowered.
“It is important to remember that the risk of dying from COVID-19 in middle-aged people with diabetes is very low in absolute terms compared to the elderly,” said lead researcher Andrew P. McGovern, MD, of Royal Devon & Exeter Hospital, Exeter. , United Kingdom, in a press release from its agency.
However, he said that “strategies for determining priority groups for vaccination must take into account the disproportionate relative risk of COVID-19 death in middle-aged people with type 2 diabetes whose risk of COVID-19 has already increased with their age.”
McGovern informed Medscape Medical News that the magnitude of the effect of type 2 diabetes on deaths from COVID-19 is “absolutely shocking” about the new findings, and “not what you expected.”
Therefore, he said it was imperative that diabetics be put “in line” to get the vaccine “in the right place, and clearly in countries where vaccine rollout will be slower, it is more important.”
Bridget Turner, director of policy and improvement campaigns at Diabetes UK, which funded the study, said the results provide “important new insights into how much type 2 diabetes adds to the overall risk of dying from coronavirus at different ages, particularly the additional risk of that condition. increases in middle age. “
“The UK has made good progress in prioritizing those most vulnerable for vaccination, which includes all adults with diabetes,” he added in a press release, “but we need to continue to work with pace to identify and protect those people at a greater level. high risk. “
The Relationship Between COVID-19 Death and Diabetes Is Complex
The authors note that the association between COVID-19-related death and type 2 diabetes is not only a “co-effect of diabetes and age-related risk” but appears to be a “more complex” relationship, with “a disproportionately higher relative risk of excess relative risk.” death in young people with diabetes. “
To investigate this, they examined data from two UK population-based studies that previously reported age-specific hazard ratios for diabetes-related COVID-19 deaths:
Open safely, which includes 17.2 million people, 8.8% of whom have diabetes, and has an overall 90-day mortality rate of 0.06%.
QCOVID, comprising 6 million people, of whom 7% had diabetes, and had an overall 97-day mortality rate of 0.07%.
The team also looked at data from type 2 diabetes patients with severe COVID-19 from the COVID-19 Hospitalization in England Surveillance System (CHESS), which contained 19,256 patients were admitted to critical care in the UK, 18.3% of whom had diabetes.
The 30-day hospital mortality rate in this study was 26.4%.
They translated the death hazard ratio associated with COVID-19 infection in diabetics to “COVID-19 age,” which equates to additional years of “risk of death” added to the individual’s chronological age if diabetes is present.
Taking the QCOVID dataset as an example, the results showed that the diabetes-related “COVID age” for someone aged 40 was 20.4 years; which would indicate that “the risk of death [for COVID-19] similar to a 60 year old without diabetes. “
The impact of diabetes on the risk of death from COVID-19 decreases with age, so that diabetic patients aged 50 have COVID-19 aged 16.4 years. This drops to 12.1 years in someone who is 60, and 8.1 years in someone who is 70, meaning the latter has the same risk of dying from COVID-19 as someone without diabetes who is 78 years old.
Similar results were obtained when the team looked at data from the OpenSAFELY study.
But when they looked at the effect of diabetes on the risk of dying from COVID-19 in the CHESS data set, it was less visible..
Just Looking At Diabetes Is Too Simple, But It’s An Easy Marker For Vaccination
The investigators acknowledge that “only considering age and diabetes status when assessing COVID-19-related risk … is an oversimplification,” because factors such as body mass index (BMI), diabetes duration, and glycemic control are also known to play an important role. authority.
However, they said consideration of these factors was “impractical for vaccine rollout at the population level.”
“The time-critical nature of the COVID-19 vaccination population requires pragmatic group level priority, which is the approach initiated by the government so far,” the team concluded.
This study was supported by Diabetes UK. Study author John M. Dennis was supported by an Independent Fellowship funded by the Research England’s Expanding Excellence in England (E3) fund and by the NIHR Exeter Clinical Research Facility. McGovern is supported by the NIHR Exeter Clinical Research Facility.
Diabetology. Published online February 8, 2021. Full text