Diabetes, glycaemic control, and risk of COVID-19 hospitalisation: population-based, prospective cohort study

Abstract

Objective

We aimed to examine the prospective association of diabetes and glycaemic control with COVID-19 hospitalisation in a large community-based cohort study.

Methods and Study Design.

Participants ( N = 337,802, aged 56.4 ± 8.1 yr; 55.1% women) underwent biomedical assessments at baseline as part of the UK Biobank prospective cohort study. The outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16-March-2020 to 26-April-2020.

Results

At follow up, 649 cases COVID-19 were recorded. In multivariable adjusted analyses, risk of COVID-19 was elevated in people with undiagnosed diabetes at baseline (A1C ≥ 6.5%) (risk ratio = 2.68; 95% confidence interval: 1.66, 4.33) and poorly controlled (A1C ≥ 8.6%) diagnosed diabetes (1.91;1.04, 3.52). There was a dose-dependent increase in risk of COVID-19 with increasing A1C, that persisted in multivariable adjusted models (per SD [0.9%]: 1.07; 1.03, 1.11; p[trend] < 0.001).

Conclusion

In this large community-based sample, higher levels of A1C within the normal range was a risk factor for COVID-19. Glucose regulation may play a key role in immune responses to this infection. Undiagnosed cases of diabetes in the general community may present a particularly high risk.

Highlights

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  Whether diabetes has a role as a risk factor in the occurrence of COVID-19- is unknown

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  We examined the aetiological relation of both diabetes and A1C with new cases of COVID-19

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  Higher levels of A1C within the normal range was a risk factor for COVID-19.

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  Glucose regulation may play a key role in immune responses to this infection.