Every day the media publish death statistics. Each death represents an individual person:
‘Tributes have been paid to a popular member of a Cornish theatre group who died after contracting coronavirus. Mick Boyles, who lived… near Liskeard, was taken to Derriford Hospital in Plymouth on March 27, but passed away two days later… 78-year-old Mick had an existing heart condition and diabetes… Mick was formerly a partner at a dental practice in Liskeard. He and Ruth were members of the Sterts theatre group for many years… Sterts director Peter Woodward, who had known Mick for around 20 years, described him as a “generous and essentially soft-hearted man”.’
Was the fact that this generous, soft-hearted man had diabetes relevant? Yes.
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A third of people dying with COVID-19 in hospital had diabetes2
Between 1 March and 11 May 2020, people in England alive on 19 February 2020 were included in a population cohort study. The National Diabetes Audit, including data from 98% of general practices in England, was linked to other health data sets to provide a unique analysis of a whole nation’s experience of COVID-19 and mortality among people with diabetes. This is the largest study relating to COVID-19.
On 19 February 2020, 61,414,470 people were registered with GP practices among whom 263,830 (0.4%) had type 1 diabetes and 2,864,670 (4.7%) had type 2 diabetes; 41,750 (0.1%) had other forms of diabetes.
By 11 May 2020 there were 23,804 deaths in hospital with COVID-19. Among those who died were 365 (1.5%) people with type 1 diabetes, 7466 (31.4%) with type 2 diabetes, and 69 (0.3%) with other forms of diabetes. Thus a shocking total of 33.2% of all deaths in hospital were among people with diabetes.
‘Adjusted for age, sex, deprivation, ethnicity, region and cardiovascular comorbidity, the odds ratio for dying in-hospital with COVID-19 in people with Type 1 diabetes compared to the population without known diabetes was 2.86 and 1.81 for people with Type 2 diabetes.’
Deaths in people with diabetes have more than doubled during the COVID-19 epidemic3
The study above only included people who died in hospital. A cohort of people with type 1 or type 2 diabetes in the National Diabetes Audit 2018/19 in England who were alive on 1 January 2020 were followed until 1 May 2020. All weekly deaths, whether in or out of hospital and including those in care homes, were compared with those in previous years.
Among the 3,154,300 people with diabetes, 265,090 had type 1 diabetes and 2,889,210 had type 2 diabetes. In the first four months of 2020, 71,160 of these people had died. The death certificate of 9795 of them included COVID-19, with COVID-19 as the underlying cause of death in 9341 (95.4%). People who were older, men, had black or Asian ethnicity, or were in the most socio-economically deprived groups were more likely to die with COVID-19 than comparators.
Between 3 April and 1 May 2020 more than twice the number of people with diabetes died each week compared with the same weeks in previous years. This equates to 2500–3000 more deaths a week among people with diabetes.
This study included deaths in hospital and the community. Some of the 61,365 people who died without COVID-19 recorded as a cause could still have had the virus. Some may have died because they did not seek or receive usual care for diabetes-related or other problems.
The risk of COVID-19 mortality increases with hyperglycaemia and obesity3
After adjusting for other risk factors, the degree of hyperglycaemia was strongly linked to the risk of death with COVID-19. In people with diabetes with an HbA≥86mmol/L (10%) the hazard ratio was 2.19 in type 1 diabetes and 1.62 in type 2 diabetes.
The relationship between BMI and COVID-19 associated mortality was U-shaped. For people with a BMI