Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors.
Mortality in People with Type 2 Diabetes Following SARS-CoV-2 Infection: A Population Level Analysis of Potential Risk Factors.
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SARS-COV-2感染后2型糖尿病患者的死亡率：潜在危险因素的人群水平分析。
DOI：
10.1007/s13300-022-01259-3
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发表时间：
2022-05
期刊：
影响因子：
3.8
通讯作者：
Gibson, J. Martin
中科院分区：
文献类型：
--
作者：
Heald, Adrian H.;Jenkins, David A.;Williams, Richard;Sperrin, Matthew;Mudaliar, Rajshekhar N.;Syed, Akheel;Naseem, Asma;Davies, Kelly A. Bowden;Peng, Yonghong;Peek, Niels;Ollier, William;Anderson, Simon G.;Delanerolle, Gayathri;Gibson, J. Martin
目前正在进行研究，以加深我们对先前诊断为2型糖尿病（T2DM）的人在感染COVID-19后变得严重不适的风险有多大影响的理解。在这项研究中，我们着手确定与非T2DM患者相比，T2DM患者在COVID-19感染后死亡的相对可能性。这是在英国进行的一项城市人口研究。对居住在大曼彻斯特市（人口282万）的人进行了电子健康记录数据分析，这些人被诊断为2型糖尿病，随后被确诊为COVID-19感染。每个T2DM患者（n = 13,807）与3名感染covid -19的非糖尿病对照组（n = 39,583）匹配。数据从2020年1月1日至2021年6月30日的大曼彻斯特护理记录（GMCR）数据库中提取。社会劣势是通过汤森分数来评估的。将2型糖尿病患者与非糖尿病对照组的死亡率进行比较；采用单变量和多变量logistic回归确定影响住院相对可能性的潜在预测因素。对于T2DM患者，他们在COVID-19阳性检测后的死亡率为7.7%，而匹配对照组为6.0%；死亡相对危险度（RR）为1.28。在T2DM患者组中进行的单因素分析显示，服用二甲双胍、钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）或胰高血糖素样肽1 （GLP-1）激动剂的患者在COVID-19感染后死亡的可能性较低。估计肾小球滤过率（eGFR）和高血压与死亡率增加相关，比值比分别为0.96（95%可信区间0.96 - 0.97）和1.92（95%可信区间1.68-2.20）。在诊断为慢性阻塞性肺疾病（COPD）或严重持续性精神疾病但未患有哮喘的人群中，以及服用阿司匹林/氯吡格雷/胰岛素的人群中，COVID-19感染后死亡的可能性也更高。2型糖尿病患者吸烟显著增加死亡率（优势比1.46；95%可信区间1.29-1.65）。在对T2DM患者和对照组的综合分析中，多元回归模型表明，与较高的死亡可能性（占26%的方差）独立相关的因素是T2DM、年龄、男性性别和社会剥夺（较高的Townsend评分）。在确诊感染COVID-19后，许多因素与T2DM患者的死亡率相关。二甲双胍、SGLT2is或GLP-1激动剂的处方和不吸烟状态似乎与T2DM患者死亡风险降低有关。年龄、男性性别和社会劣势与死亡风险增加有关。
Research 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. Analysis 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. For 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). Following 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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