MRC Epidemiology Unit Director Nick Wareham has contributed to recent research that is being used to help the NHS offer greater support to those with diabetes. The research, published in in two papers in Lancet Diabetes and Endocrinology shows that people living with diabetes face a significantly higher risk of dying with COVID-19. A third of deaths in England are associated with the condition.

The studies reveal that people living with type 1 diabetes are at three and a half times the risk, and people living with type 2 are at double the risk of dying in hospital with the virus, compared to people without diabetes. However, by far the strongest risk factor for dying with the virus is age, and people with type 1 diabetes are on average younger than people with type 2 diabetes.

Overall, 7,466 of those who died in hospitals in England had type 2 and 365 who died had type 1 diabetes, and the research suggests that the threat for those under 40 with type 1 or type 2 diabetes is very low, with no recorded deaths in those under 20. It is thought that the risk to people with diabetes and the virus is in line with the extra risk seen in other infectious conditions such as pneumonia.

The study also shows that in people with both type 1 and type 2 diabetes, even when all other known factors are taken into account, higher blood glucose levels and obesity are linked to higher risk.

Findings also show:

• The overall death rate for people with diabetes doubled during the early stage of the pandemic.
• In both type 1 and type 2 diabetes, men, people of black or Asian ethnicity, and people living in more deprived communities, were at higher risk.
• In both type 1 and type 2 diabetes, those with pre-existing kidney disease, heart failure and previous stroke, were also at higher risk.

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, digital consultations, and a dedicated new helpline for advice and support for people treated with insulin.”

The NHS responds

As a result of this research, the NHS in England has called on people with diabetes to access help available to them, including a new dedicated helpline and online tools to help manage the condition during the outbreak. You can read more about the NHS support being offered here.

Publications

• “Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study.” Emma Barron et al, Lancet Diabetes and Endocrinology 13 August 2020 DOI: 10.1016/S2213-8587(20)30272-2
• “Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study” Naomi Holman et al, Lancet Diabetes and Endocrinology 13 August 2020. DOI: 10.1016/S2213-8587(20)30271-0