For the past year, the COrona VIrus Disease-2019 (COVID-19) pandemic has spread around the world leading to more than 2.0 million deaths, with higher risk of severe illness in older adults and those with comorbidities including diabetes. It is becoming increasingly evident that the main risk factor for severe outcomes is age: elderly people, over 70, had the highest burden of risk associated with COVID-19. In contrast, diabetes is prevalent in people from a wide range of ages and whether it is associated with severe outcomes in all age groups is not known. The aim of this study was to compare severe outcomes among patients with and without diabetes hospitalized for COVID-19 according to age in a large French repository
We conducted a retrospective observational cohort study of 6,314 consecutive patients hospitalized for COVID-19 between February and June 30 2020, and follow-up recorded until 30 September 2020, in the Paris metropolitan area, France. 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.
Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables 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 in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 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 under 50.
Our study suggests physicians dealing with SARS-CoV-2 infected subjects should consider diabetes as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults.
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