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Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults
Marc Diedisheim1,2, Etienne Dancoisne3,4, Jean-François Gautier1,5
1Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, 75006 Paris, France.
Insights
Diabetes increases the risk of severe coronavirus disease 2019 (COVID-19) outcomes, particularly in younger adults. This diabetes-associated risk is highest in those under 50 and diminishes significantly in older individuals.
Area of Science:
- Infectious Diseases
- Endocrinology
- Public Health
Background:
- Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19).
- The impact of diabetes on COVID-19 severity across different age groups requires further clarification.
Purpose of the Study:
- To investigate the association between diabetes and severe COVID-19 outcomes.
- To analyze this association across various age categories in hospitalized patients.
Main Methods:
- Retrospective observational cohort study of 6314 hospitalized COVID-19 patients.
- Follow-up until September 2020 in the Paris metropolitan area.
- Composite outcome of mortality and/or orotracheal intubation analyzed by age groups.
Main Results:
- Diabetes was present in 39% of patients, with higher composite outcomes observed.
- The diabetes-associated risk for severe COVID-19 was inversely proportional to age, highest in those under 50.
- Adjusted hazard ratio for diabetes was significant only in patients younger than 50 years.
Conclusions:
- Diabetes is an independent risk factor for severe COVID-19, especially in younger adults.
- The risk associated with diabetes is more pronounced in individuals under 70 years compared to older adults.
Context:
Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear.
Objective:
To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories.
Design Setting And Participants:
We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020.
Main Outcome Measure(S):
The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories.
Results:
Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]).
Conclusions:
Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.
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