Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: A nationwide retrospective cohort study.
Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: A nationwide retrospective cohort study.
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DOI：
10.1016/j.lanepe.2021.100105
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Rosengren A
中科院分区：
文献类型：
--
作者：
Rawshani A;Kjölhede EA;Rawshani A;Sattar N;Eeg-Olofsson K;Adiels M;Ludvigsson J;Lindh M;Gisslén M;Hagberg E;Lappas G;Eliasson B;Rosengren A
感染 SARS-CoV-2 是否会导致糖尿病患者需要住院或重症监护的风险过高尚未有报道，也没有糖尿病的危险因素与这些结果风险增加相关。我们纳入了 2020 年 1 月 1 日存活的 44,639 名和 411,976 名 1 型和 2 型糖尿病成年患者，并将他们与年龄、性别和居住县匹配的对照组（n=204,919 和 1,948,900）进行比较。使用 Cox 回归分析估计了与 COVID-19 相关的住院率、重症监护室入院率和死亡率的年龄和性别标准化率，并计算了风险比。共有 10,486 人住院治疗，1,416 人进入重症监护室。共有 1,175 名糖尿病患者和 1,820 名匹配对照者死于 COVID-19，其中 53•2% 已住院治疗，10•7% 已接受重症监护。与对照组相比，2型糖尿病患者因 COVID-19 住院的年龄和性别调整风险比 (HR) 为 2•22 (95%CI 2•13-2•32)，进一步调整社会人口因素、药物治疗和合并症后，该风险比 (HR) 降至 HR 1•40, 95%CI 1•34-1•47)，因 COVID-19 入住 ICU 的风险较高（年龄和性别调整后的 HR 2•49，95%CI 2•22-2•79，调整后降至 1•42，95%CI 1•25-1•62，并且因 COVID-19 导致的死亡风险增加（年龄和性别调整后的 HR 2•19，95%CI 2•03-2•36，完全调整 1•50，95%CI 1•39-1•63）。因 1 型糖尿病而住院的 COVID-19 的年龄和性别调整 HR 为 2•10，95%CI 1•72-2•57），调整后降至 1•25，95%CI 0•3097-1•62）• 1 型糖尿病患者因 COVID-19 需要重症监护的可能性是调整后的两倍（HR 1•49， 95%CI 0•75-2•92)，更有可能死于COVID-19 (HR 2•90，95% CI 1•6554-5•47)，但与其他因素无关(HR 1•38，95% CI 0•64-2•99)。在糖尿病患者中，糖化血红蛋白水平升高与大多数结果的风险较高相关。在这项全国性研究中，2 型糖尿病与 COVID-19 住院、重症监护和死亡风险增加独立相关。 1 型糖尿病患者接受重症监护和死亡的情况很少，尽管所有三种结果的风险均显着增加，但在调整混杂因素后，没有独立风险持续存在。
Whether infection with SARS-CoV-2 leads to excess risk of requiring hospitalization or intensive care in persons with diabetes has not been reported, nor have risk factors in diabetes associated with increased risk for these outcomes. We included 44,639 and 411,976 adult patients with type 1 and type 2 diabetes alive on Jan 1, 2020, and compared them to controls matched for age, sex, and county of residence (n=204,919 and 1,948,900). Age- and sex-standardized rates for COVID-19 related hospitalizations, admissions to intensive care and death, were estimated and hazard ratios were calculated using Cox regression analyses. There were 10,486 hospitalizations and 1,416 admissions into intensive care. A total of 1,175 patients with diabetes and 1,820 matched controls died from COVID-19, of these 53•2% had been hospitalized and 10•7% had been in intensive care. Patients with type 2 diabetes, compared to controls, displayed an age- and sex-adjusted hazard ratio (HR) of 2•22, 95%CI 2•13-2•32) of being hospitalized for COVID-19, which decreased to HR 1•40, 95%CI 1•34-1•47) after further adjustment for sociodemographic factors, pharmacological treatment and comorbidities, had higher risk for admission to ICU due to COVID-19 (age- and sex-adjusted HR 2•49, 95%CI 2•22-2•79, decreasing to 1•42, 95%CI 1•25-1•62 after adjustment, and increased risk for death due to COVID-19 (age- and sex-adjusted HR 2•19, 95%CI 2•03-2•36, complete adjustment 1•50, 95%CI 1•39-1•63). Age- and sex-adjusted HR for COVID-19 hospitalization for type 1 diabetes was 2•10, 95%CI 1•72-2•57), decreasing to 1•25, 95%CI 0•3097-1•62) after adjustment• Patients with diabetes type 1 were twice as likely to require intensive care for COVID-19, however, not after adjustment (HR 1•49, 95%CI 0•75-2•92), and more likely to die (HR 2•90, 95% CI 1•6554-5•47) from COVID-19, but not independently of other factors (HR 1•38, 95% CI 0•64-2•99). Among patients with diabetes, elevated glycated hemoglobin levels were associated with higher risk for most outcomes. In this nationwide study, type 2 diabetes was independently associated with increased risk of hospitalization, admission to intensive care and death for COVID-19. There were few admissions into intensive care and deaths in type 1 diabetes, and although hazards were significantly raised for all three outcomes, there was no independent risk persisting after adjustment for confounding factors.
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