COVID-19 Severity is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes

Research Design and Methods: We conducted a prospective cohort study to identify COVID-19 cases across a regional healthcare network of 137 service locations. Using an electronic health record query, chart review, and patient contact, we identified clinical factors influencing illness severity.

Results: We identified COVID-19 in 6,138, 40, and 273 patients without diabetes and with type 1 and type 2 diabetes, respectively. Compared with not having diabetes, people with type 1 diabetes had adjusted odds ratios (ORs) of 3.90 (95% CI 1.75-8.69) for hospitalization and 3.35 (95% CI 1.53-7.33) for greater illness severity, which was similar to risk in type 2 diabetes. Among type 1 diabetes patients, glycosylated hemoglobin (HbA1c), hypertension, race, recent diabetic ketoacidosis (DKA), health insurance status, and less diabetes technology use were significantly associated with illness severity.

Conclusions: Diabetes status, both type 1 and type 2, independently increases the adverse impacts of COVID-19. Potentially modifiable factors (e.g., HbA1c) had significant but modest impact compared to comparatively static factors (e.g. race, insurance) in type 1 diabetes indicating an urgent and continued need to mitigate SARS-CoV-2 infection risk in this community.