Association between diabetes and worse COVID-19 outcomes more marked in younger adults

Among patients hospitalized with COVID-19, diabetes was a more significant risk factor for death, intensive care, or intubation in those younger than 50 years compared to older patients, a retrospective French study found.

Diabetes was associated with increased risk of severe outcomes from COVID-19, but the effect varied by patient age, a recent study found.

To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes, researchers conducted a retrospective observational cohort study of 6,314 consecutive patients hospitalized for COVID-19 between February and June 2020, with follow-up until September. A database of 39 public hospitals in and around Paris was used to identify adults with positive SARS-CoV-2 polymerase chain reaction tests. The primary outcome was a composite of in-hospital mortality or ICU admission and intubation. Results were published by the Journal of Clinical Endocrinology & Metabolism on June 1.

During a 90-day follow-up period from admission, 35% of study patients died in the hospital or were admitted to the ICU and intubated. Diabetes was significantly associated with a higher risk for the primary outcome: 39% versus 32% (adjusted hazard ratio [HR], 1.13; 95% CI, 1.04 to 1.25). Among patients without diabetes, rates of the primary outcome increased steadily by age, from 26% among patients younger than age 50 years to 35% among those older than age 80 years. However, for those with diabetes, the increase in associated risk decreased with age from an HR of 1.52 (95% CI, 1.18 to 1.97) for patients younger than age 50 years to 1.30 (95% CI, 1.08 to 1.57) for patients ages 60 to 70 years, and it was not significant for those older than age 70 years. The outcome of mortality alone was higher in patients with diabetes than in those without diabetes (26% vs. 22%; P<0.001), but the difference was significant only in patients younger than age 50 years (HR, 1.81; 95% CI, 1.14 to 2.87).

“Taken together, these results might suggest that over 50, diabetes-related risk is weakened by all other comorbidities or conditions associated with age,” the authors wrote. “These findings are consistent with previous observational data in the general population of type 2 diabetes, beyond the scope of COVID-19, showing that diabetes-associated risk of death decreased in a stepwise fashion from younger to older age groups.”