Rawshani Aidin, Kjölhede Elin Allansson, Rawshani Araz, Sattar Naveed, Eeg-Olofsson Katarina, Adiels Martin, Ludvigsson Johnny, Lindh Marcus, Gisslén Magnus, Hagberg Eva, Lappas Georgios, Eliasson Björn, Rosengren Annika
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden.
Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, University of Gothenburg, Sweden.
Lancet Reg Health Eur. 2021 May;4:100105. doi: 10.1016/j.lanepe.2021.100105. Epub 2021 Apr 30.
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.
2019冠状病毒病（SARS-CoV-2）感染是否会导致糖尿病患者住院或重症监护的风险增加，此前尚无报道，糖尿病患者中与这些不良后果风险增加相关的危险因素也未明确。
我们纳入了2020年1月1日存活的44639例1型糖尿病成年患者和411976例2型糖尿病成年患者，并将他们与年龄、性别和居住县相匹配的对照组进行比较（对照组分别为204919例和1948900例）。估算了COVID-19相关住院、重症监护入院和死亡的年龄和性别标准化率，并使用Cox回归分析计算风险比。
共发生10486例住院和1416例重症监护入院。共有1175例糖尿病患者和1820例匹配的对照死于COVID-19，其中53.2%曾住院治疗，10.7%曾接受重症监护。与对照组相比，2型糖尿病患者因COVID-19住院的年龄和性别调整风险比（HR）为2.22（95%CI 2.13-2.32），在进一步调整社会人口学因素、药物治疗和合并症后降至HR 1.40（95%CI 1.34-1.47）；因COVID-19入住重症监护病房的风险更高（年龄和性别调整HR 2.49，95%CI 2.22-2.79，调整后降至1.42，95%CI 1.25-1.62），因COVID-19死亡的风险增加（年龄和性别调整HR 2.19，95%CI 2.03-2.36，完全调整后为1.50，95%CI 1.39-1.63）。1型糖尿病患者因COVID-19住院的年龄和性别调整HR为2.10（95%CI 1.72-2.57），调整后降至1.25（95%CI 0.97-1.62）。1型糖尿病患者因COVID-19需要重症监护的可能性是对照组的两倍，但调整后并非如此（HR 1.49，95%CI 0.75-2.92），且死于COVID-19的可能性更大（HR 2.90，95%CI 1.65-5.47），但并非独立于其他因素（HR 1.38，95%CI 0.64-2.99）。在糖尿病患者中，糖化血红蛋白水平升高与大多数不良后果的风险较高相关。
在这项全国性研究中，2型糖尿病与COVID-19住院、重症监护入院和死亡风险增加独立相关。1型糖尿病患者的重症监护入院和死亡病例较少，尽管所有三种不良后果的风险均显著升高，但在调整混杂因素后不存在独立风险。
