The research found that a third of the deaths in hospital in England from COVID-19 involved patients who had diabetes. Of the 23,804 COVID-19 deaths between 1 March and 11 May, 7,466 (31.4%) patients had type 2 diabetes, while 365 (1.5%) had type 1 diabetes.
The study is the first to investigate the risks of death in hospital with COVID-19 by type of diabetes.
As with the general population, the study found that age plays a significant role in the risk of death. There was a 700-fold difference in risk of death between those under 40 and those over 80, with mortality rates ranging from 0.5 per 100,000 in those aged 0-39 to 415.8 per 100,000 in those aged 80 or over.
However, across all age groups mortality rates were significantly higher for patients with type 1 or type 2 diabetes than for the general population and they 'were significantly higher for type 1 diabetes than type 2 diabetes for older age groups,' the study said. Indivudals with type 1 diabetes who died in hospital with COVID-19 were also younger on average than all hospital deaths.
Higher blood glucose levels and obesity were linked to a higher risk of death in patients with both type 1 and type 2 diabetes, even when other factors were taken into account.
Ethnicity and deprivation
Men, people of black, Asian or minority ethnic (BAME) backgrounds and those living in more deprived communities were also at higher risk of death, which reflects death rates from COVID-19 in the wider population.
Previous research has found that risk of death from COVID-19 is two to three times higher for people from BAME groups compared with the population as a whole. Analysis by the Office for National Statistics (ONS), meanwhile, has shown that people in the most deprived areas of England have died at more than twice the rate of those in the least deprived areas.
This latest study found that there was a higher proportion of deaths in people from BAME backgrounds with diabetes than in all hospital deaths. It also found there was a 'marked inverse relationship with deprivation'. Some 29.6% of deaths in people with type 1 diabetes were in patients in the most deprived quintile and only 10.4% were in the least deprived quintile.
Diabetes patients who had heart failure, pre-existing kidney disease, or who had previously had a stroke were also at higher risk of dying from COVID-19.
New insulin helpline
In light of the findings, NHS England has encouraged patients with diabetes to contact their GP or diabetes team if they are worried about their condition during the pandemic.
It has also set up a new helpline, in partnership with Diabetes UK, pharmaceutical giant Novo Nordisk and medical device manufacturer Insulet, to provide advice to those who need help with insulin.
Patients with type 1 and type 2 diabetes will also be able to access additional support from online educational services to help them better manage their condition, NHS England said.
Professor Jonathan Valabhji, national clinical director for diabetes and obesity and lead author of the study said: ‘This research shows the extent of the risk of coronavirus for people with diabetes and the different risks for those with type 1 and type 2 diabetes.
‘Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.
‘This can be worrying news but we would like to reassure people that the NHS is here for anyone with concerns about diabetes – and has put extra measures in place to help people and keep them safe, including online sites to support people to care for themselves, telephone and digital consultations, and a dedicated new helpline for advice and support for people treated with insulin.’
Lower risk for younger people
Diabetes UK director of policy Bridget Turner said: ‘This new data sheds much-needed light on which groups of people with diabetes are more likely to experience poor outcomes if they catch coronavirus.
'It’s consistent with what we know about the impact of coronavirus on the general population; that poorer outcomes are very strongly linked to older age. The numbers of people with all types of diabetes dying in hospital from coronavirus under the age of 40 were incredibly small, suggesting the risk for younger people is considerably lower.
‘The most important thing anyone with diabetes can do is try their best to manage their condition carefully, keeping their blood sugar in range as much as possible. All people with diabetes should also follow stringent social distancing measures to reduce their chances of catching the virus altogether.'
Public Health England is due to report by the end of this month on how factors including ethnicity, gender and obesity affect outcomes in patients and NHS staff infected with COVID-19.