Personer med diabetes drabbas värre av covid-19
Personer med typ 2-diabetes som smittas med covid-19 har en signifikant ökad risk att behöva intensivvård. Det visar en stor studie finansierad av Hjärt-Lungfonden. Studien som omfattade mer än två och en halv miljoner svenskar, varav 500 000 från diabetesregistret, visar även på ökad dödlighet till följd av covid-19 hos personer med typ 2-diabetes.
– Forskningen inom diabetesområdet har varit mycket framgångsrik med nya behandlingsmetoder och läkemedel. Men antalet personer med typ 2 diabetes diabetes ökar i Sverige.
Nu hoppas vi att de här nya forskningsresultaten ska kunna bidra till att rädda fler liv, säger Kristina Sparreljung, generalsekreterare för Hjärt-Lungfonden.
I Sverige har omkring en halv miljon personer diabetes, varav 90 procent har typ 2-diabetes. Den svenska studien har undersökt antalet nya fall och risken för intensivvårdsbehandling, sjukhusinläggning och dödlighet till följd av covid-19 hos personer med tyyp 2 diabetes.
Studien jämförde personer med diabetes mot slumpmässigt utvalda ålders-, köns- och region-matchade kontroller utan diabetes, från befolkningen. Totalt omfattade studien 2,6 miljoner svenskar, varav 500 000 från diabetesregistret.
– Studien visar att risken för personer med typ 2-diabetes att läggas in på sjukhus på grund av covid-19 var 1,4 gånger högre än för dem utan diabetes. Alltså en 40 procentig riskökning, säger Aidin Rawshani, forskare vid Göteborgs universitet.
Även vid omfattande justering för störfaktorer noterades en signifikant ökad risk för intensivvård av patienter med covid-19 med 1,4 gånger och en ökad dödlighet till följd av covid-19 med 1,5 gånger hos personer med typ 2-diabetes jämfört med matchade kontroller.
För personer med typ 1-diabetes noterades en signifikant högre risk för samtliga utfall. Däremot noterades för typ 1 diabetes ingen signifikant överrisk för utfallen i statistiska modeller med komplett justering för riskfaktorer.
Studien startade 1 januari 2020 och pågick fram till 15 augusti 2020.
Fakta om studien:
Namn på tidskrift där artikeln publiceras: The Lancet Regional Health – Europé
Datum för publiceringen: Maj 2021
Artikelns titel: Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: a nationwide retrospective cohort study
Metod: Vi använde standardiserade incidens rater för att studera insjuknandet i allvarliga covid-19 relaterade händelser.
Typ av studie: Observationsstudie
Länk till studien https://authors.elsevier.com/sd/article/S266677622100082X
Press release från Hjärtlungfonden
LÄS HELA STUDIEN INKL ABSTRACT
Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: A nationwide retrospective cohort study
Author links open overlay panelAidinRawshaniabcElin AllanssonKjölhedeacArazRawshaniabcNaveedSattardKatarinaEeg-OlofssonacMartinAdielsabcJohnnyLudvigssoneMarcusLindhaMagnusGissléncfEvaHagbergacGeorgiosLappasaBjörnEliassonacAnnikaRosengrenabc
Whether infection with SARS-CoV-2 leads to excess risk of requiring hospitalization or intensive care in persons with diabetes has not been reported, nor have risk factors in diabetes associated with increased risk for these outcomes.
We included 44,639 and 411,976 adult patients with type 1 and type 2 diabetes alive on Jan 1, 2020, and compared them to controls matched for age, sex, and county of residence (n=204,919 and 1,948,900). Age- and sex-standardized rates for COVID-19 related hospitalizations, admissions to intensive care and death, were estimated and hazard ratios were calculated using Cox regression analyses.
There were 10,486 hospitalizations and 1,416 admissions into intensive care. A total of 1,175 patients with diabetes and 1,820 matched controls died from COVID-19, of these 53•2% had been hospitalized and 10•7% had been in intensive care.
Patients with type 2 diabetes, compared to controls, displayed an age- and sex-adjusted hazard ratio (HR) of 2•22, 95%CI 2•13-2•32) of being hospitalized for COVID-19, which decreased to HR 1•40, 95%CI 1•34-1•47) after further adjustment for sociodemographic factors, pharmacological treatment and comorbidities, had higher risk for admission to ICU due to COVID-19 (age- and sex-adjusted HR 2•49, 95%CI 2•22-2•79, decreasing to 1•42, 95%CI 1•25-1•62 after adjustment, and increased risk for death due to COVID-19 (age- and sex-adjusted HR 2•19, 95%CI 2•03-2•36, complete adjustment 1•50, 95%CI 1•39-1•63).
Age- and sex-adjusted HR for COVID-19 hospitalization for type 1 diabetes was 2•10, 95%CI 1•72-2•57), decreasing to 1•25, 95%CI 0•3097-1•62) after adjustment• Patients with diabetes type 1 were twice as likely to require intensive care for COVID-19, however, not after adjustment (HR 1•49, 95%CI 0•75-2•92), and more likely to die (HR 2•90, 95% CI 1•6554-5•47) from COVID-19, but not independently of other factors (HR 1•38, 95% CI 0•64-2•99). Among patients with diabetes, elevated glycated hemoglobin levels were associated with higher risk for most outcomes.
In this nationwide study, type 2 diabetes was independently associated with increased risk of hospitalization, admission to intensive care and death for COVID-19. There were few admissions into intensive care and deaths in type 1 diabetes, and although hazards were significantly raised for all three outcomes, there was no independent risk persisting after adjustment for confounding factors.
Research in context
Evidence before this study
The majority of all persons, with and without diabetes, infected with SARS-CoV-2, survive and do not require hospitalization or intensive care.
Findings from multiple studies have shown that people with both type 1 and type 2 diabetes have an increased risk of in-hospital death, of death or a composite of mortality and need of intensive care from COVID-19.
Among persons with diabetes of either type COVID-19-related mortality is associated with older age, male sex, socioeconomic deprivation, non-white ethnicity, established cardiovascular disease, and impaired renal function, glycemic control and with both obesity and underweight.
However, from a public health point of view COVID-19 presents a much more complex problem in that hospitals are frequently overwhelmed, both with respect to total beds but also to intensive care with an excessive toll on human and other resources. To which extent deaths, hospitalizations, and intensive care overlap will obviously depend on organization of health care and care of the elderly, as well as reporting on deaths, but with these limitations in mind, no studies have attempted to report findings for people with and without diabetes separately for these outcomes. We searched the PubMed and medRxiv using the search terms “COVID-19”, “SARS-CoV-2”, “diabetes” (in the publication title) and (hospitalization OR intensive care OR critical care OR mortality) for English-language publications.
We were unable to identify any study that established risk of hospitalization, being in need of intensive care, or death, separately for each outcome, compared to population controls without diabetes.
Added value of this study
This is, to our knowledge, the first study to address to which extent persons with diabetes type 1 and 2 have an excess risk of being hospitalized, requiring intensive care, or die (in- or outside hospital) compared to persons without diabetes from the general population.
We used data from a nationwide Swedish diabetes registry with 90% coverage, analyzing a total of 44,478 patients with type 1 diabetes and 385,021 persons with type 2 diabetes; comparing them with over 1.8 million controls without diabetes, matched for age, sex, and county. Altogether, 3,587 people with diabetes and 6,899 controls were hospitalized, 469 with diabetes and 947 controls were admitted to intensive care, with 1,175 with diabetes and 1,820 controls succumbing to COVID-19. Of all deaths, only 53% had been hospitalized and 11% had been in intensive care.
Compared to controls, individuals with type 2 diabetes were twice as likely to be hospitalized, to require intensive care, and to die. After adjustment for comorbidities and pharmacological treatment, the excess risks were reduced but remained significant.
Persons with type 1 diabetes had excess risk of being hospitalized, needing intensive care and a 3-fold risk to die compared to controls, but after adjustment for covariates there was no significant excess risk for either outcome; there were however only 21 cases requiring intensive care, and 21 deaths among those with diabetes type 1; the latter at an average age of 71 years.
Among people with diabetes, poor metabolic control and obesity were associated with worse outcomes.
Implications of all the available evidence
Patients with diabetes type 2, compared to population controls, were 2 times more likely to require hospitalization, to be admitted to intensive care and to die.
This was partly, but not entirely, due to comorbid conditions, differences in medications, and socioeconomic factors. Patients with type 1 diabetes had 3 times higher death rates than expected; but this was concentrated among those older than 55 years.
Good metabolic control and maintaining a healthy weight are measures that may prevent persons with diabetes from falling seriously ill or die from COVID-19.
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