In late May, we wrote about the first studies to explicitly analyze the health outcomes of people with Type 1 diabetes during the coronavirus pandemic. At the time, the two studies, researched and written by teams from the United Kingdom’s National Health Service, were made available online as pre-prints and had not yet been peer reviewed. We advised readers to take the results with a grain of salt.
Well, on August 13, the same studies were published by the The Lancet’s special diabetes and endocrinology outlet. The work has been peer-reviewed and now comes with the imprimatur of one of the world’s most prestigious medical journals. Accordingly, we can be more confident in the results.
What do the studies say? The bottom line certainly isn’t good for people with Type 1 diabetes and for those that care for them. After adjusting for demographic factors and other preexisting health conditions, patients with Type 1 diabetes that were admitted to hospitals with COVID-19 were nearly three times as likely to die as patients without diabetes.
Age remained the most significant risk factor, with risks rising precipitously above the age of 60. Across the entirety of the United Kingdom during the time sampled, there were zero COVID-19 deaths recorded for people with Type 1 diabetes under the age of 20, and deaths under the age of 49 were rare enough that the precise number was actually suppressed due to privacy concerns. The authors concluded that “Even with the additional risk conferred by diabetes, people younger than 40 years with either type of diabetes were at very low absolute risk of in-hospital death with COVID-19 during the observation period of this study in England.”
Other factors—including gender, race, health history and economic status—also loomed large in the analysis. Men were more likely to die of COVID-19 than women, as were Black and Asian patients as compared to Caucasians. Sadly, economic deprivation also correlated with poor outcomes.
The study authors did place particular emphasis on two modifiable factors: blood sugar control and elevated weight. Both obesity and poor glycemic control were associated with an increased risk of severe illness and death.
These two studies from the UK remain the definitive treatment of the subject. Since the NHS findings were first published online in May, very little solid analysis has emerged from other sources. An American surveillance study examined only 33 patients with Type 1 diabetes that contracted COVID-19. While DKA was a common adverse outcome—nearly 50% experienced the dangerous condition—the sample was too small to draw conclusions many about.
In a recent webinar, Dr. Sharon Saydah of the CDC’s Epidemiology Task Force stated that “we really have very limited data” and that “We don’t know if people with type I diabetes or gestational diabetes may also be at increased risk for severe illness.” But the data from the two big UK studies, recently validated through publication in The Lancet, may be enough for some people with Type 1 diabetes to place themselves in the “higher risk” category of potential COVID-19 patients. Those interested in improving their own risk factors would be wise to take social distancing and infection hygiene very seriously, and may also want to consider the advice that ASweetLife contributor Dr. Mariela Glandt has offered on how to quickly improve metabolic health.