Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors View Full Text


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Article Info

DATE

2022-04-13

AUTHORS

Adrian H. Heald, David A. Jenkins, Richard Williams, Matthew Sperrin, Rajshekhar N. Mudaliar, Akheel Syed, Asma Naseem, Kelly A. Bowden Davies, Yonghong Peng, Niels Peek, William Ollier, Simon G. Anderson, Gayathri Delanerolle, J. Martin Gibson

ABSTRACT

IntroductionResearch is ongoing to increase our understanding of how much a previous diagnosis of type 2 diabetes mellitus (T2DM) affects someone’s risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK.MethodsAnalysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n = 13,807) was matched with three COVID-19-infected non-diabetes controls (n = 39,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1 January 2020 to 30 June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression.ResultsFor individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or a glucagon-like peptide 1 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96–0.97) and 1.92 (95% confidence interval 1.68–2.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29–1.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score).ConclusionFollowing confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death. More... »

PAGES

1037-1051

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s13300-022-01259-3

DOI

http://dx.doi.org/10.1007/s13300-022-01259-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1147049308

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/35416588


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    "description": "IntroductionResearch is ongoing to increase our understanding of how much a previous diagnosis of type\u00a02 diabetes mellitus (T2DM) affects someone\u2019s risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK.MethodsAnalysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n\u2009=\u200913,807) was matched with three COVID-19-infected non-diabetes controls (n\u2009=\u200939,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1\u00a0January 2020 to 30\u00a0June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression.ResultsFor individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter\u00a02 inhibitor (SGLT2i) or a glucagon-like peptide\u00a01 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96\u20130.97) and 1.92 (95% confidence interval 1.68\u20132.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29\u20131.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score).ConclusionFollowing confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death.", 
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12 schema:description IntroductionResearch is ongoing to increase our understanding of how much a previous diagnosis of type 2 diabetes mellitus (T2DM) affects someone’s risk of becoming seriously unwell following a COVID-19 infection. In this study we set out to determine the relative likelihood of death following COVID-19 infection in people with T2DM when compared to those without T2DM. This was conducted as an urban population study and based in the UK.MethodsAnalysis of electronic health record data was performed relating to people living in the Greater Manchester conurbation (population 2.82 million) who had a recorded diagnosis of T2DM and subsequent COVID-19 confirmed infection. Each individual with T2DM (n = 13,807) was matched with three COVID-19-infected non-diabetes controls (n = 39,583). Data were extracted from the Greater Manchester Care Record (GMCR) database for the period 1 January 2020 to 30 June 2021. Social disadvantage was assessed through Townsend scores. Death rates were compared in people with T2DM to their respective non-diabetes controls; potential predictive factors influencing the relative likelihood of admission were ascertained using univariable and multivariable logistic regression.ResultsFor individuals with T2DM, their mortality rate after a COVID-19 positive test was 7.7% vs 6.0% in matched controls; the relative risk (RR) of death was 1.28. From univariate analysis performed within the group of individuals with T2DM, the likelihood of death following a COVID-19 recorded infection was lower in people taking metformin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or a glucagon-like peptide 1 (GLP-1) agonist. Estimated glomerular filtration rate (eGFR) and hypertension were associated with increased mortality and had odds ratios of 0.96 (95% confidence interval 0.96–0.97) and 1.92 (95% confidence interval 1.68–2.20), respectively. Likelihood of death following a COVID-19 infection was also higher in those people with a diagnosis of chronic obstructive pulmonary disease (COPD) or severe enduring mental illness but not with asthma, and in people taking aspirin/clopidogrel/insulin. Smoking in people with T2DM significantly increased mortality rate (odds ratio of 1.46; 95% confidence interval 1.29–1.65). In a combined analysis of patients with T2DM and controls, multiple regression modelling indicated that the factors independently relating to a higher likelihood of death (accounting for 26% of variance) were T2DM, age, male gender and social deprivation (higher Townsend score).ConclusionFollowing confirmed infection with COVID-19 a number of factors are associated with mortality in individuals with T2DM. Prescription of metformin, SGLT2is or GLP-1 agonists and non-smoking status appeared to be associated with a reduced the risk of death for people with T2DM. Age, male sex and social disadvantage are associated with an increased risk of death.
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18 schema:keywords COVID-19
19 COVID-19 infection
20 COVID-19 positive test
21 GLP-1 agonists
22 Greater Manchester conurbation
23 IntroductionResearch
24 MethodsAnalysis
25 SARS-CoV-2 infection
26 SGLT2is
27 T2DM
28 Townsend score
29 UK
30 admission
31 age
32 agonists
33 analysis
34 asthma
35 chronic obstructive pulmonary disease
36 combined analysis
37 control
38 conurbation
39 cotransporter
40 data
41 database
42 death
43 death rate
44 deprivation
45 diabetes mellitus
46 diagnosis
47 disadvantages
48 disease
49 electronic health record data
50 enduring mental illness
51 factors
52 filtration rate
53 gender
54 glomerular filtration rate
55 glucagon-like peptide
56 group
57 group of individuals
58 health record data
59 higher likelihood
60 hypertension
61 illness
62 individuals
63 infection
64 inhibitors
65 insulin
66 level analysis
67 likelihood
68 likelihood of death
69 logistic regression
70 male gender
71 male sex
72 mellitus
73 mental illness
74 metformin
75 modelling
76 mortality
77 mortality rate
78 multiple regression modelling
79 multivariable logistic regression
80 non-diabetes controls
81 non-smoking status
82 number
83 number of factors
84 obstructive pulmonary disease
85 odds ratio
86 patients
87 people
88 peptides
89 population studies
90 population-level analysis
91 positive test
92 potential predictive factors
93 potential risk factors
94 predictive factors
95 prescription
96 prescription of metformin
97 previous diagnosis
98 pulmonary disease
99 rate
100 ratio
101 record data
102 record database
103 regression
104 regression modelling
105 relative likelihood
106 relative risk
107 risk
108 risk factors
109 risk of death
110 scores
111 severe enduring mental illness
112 sex
113 social deprivation
114 social disadvantage
115 sodium-glucose cotransporter
116 status
117 study
118 subsequent COVID-19
119 test
120 type 2
121 types
122 understanding
123 univariate analysis
124 schema:name Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors
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