Aged 40+ With Diabetes Ought to Be COVID-19 Vaccine Precedence

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People with type 2 diabetes at the age of 40 are at a disproportionately higher risk of dying from COVID-19 infection. This is shown by a UK analysis of three large datasets highlighting the need to prioritize vaccination among younger vulnerable patient populations.

The research was published in the journal Diabetologia on February 8.

The majority of European countries have prioritized COVID-19 vaccinations for people with type 2 diabetes, but usually only from the age of 50. However, the data from the current study suggest that this age limit should be lowered.

“It is important to remember that the risk of middle-aged people with diabetes dying from COVID-19 is very small in absolute terms compared to the elderly,” said senior researcher Andrew P. McGovern of Royal Devon & Exeter Hospital in Exeter, UK, in a press release from its institution.

However, he said that “strategies to define priority groups for vaccination must take into account the disproportionate relative risk of COVID-19 mortality in middle-aged people with type 2 diabetes, whose risk of COVID-19 is already increased by age. “

McGovern told Medscape Medical News that the magnitude of the impact of type 2 diabetes on COVID-19 deaths is “really surprising” about these new findings and “not what you would expect”.

He said it is therefore crucial that people with diabetes are queued “in the right place” for the vaccine and obviously this is more important in countries where vaccine adoption will be slower. “

Bridget Turner, director of policy campaigns and improvements at Diabetes UK, who funded the study, said the results provide “important new insights into how much type 2 diabetes increases the overall risk of dying from coronavirus at different ages, particularly that added risk that the condition adds in middle age. “

“The UK has made good progress in prioritizing those who are most vulnerable to vaccination, including all adults with diabetes,” she added in the press release. “However, we must continue to work at a rapid pace to identify and protect these people.” Risk.”

The relationship between COVID death and diabetes is complex

The authors note that the relationship between COVID-19-related mortality and type 2 diabetes is not simply an “additive effect of diabetes and age-related risk”, but a “more complex” association with a “disproportionately higher relative excess” too appears to be at risk of death in younger people with diabetes. “

To investigate this, they looked at data from two population-based studies in the UK that previously reported age-specific at-risk rates for diabetes-related COVID-19 mortality:

  • OpenSAFELY, which included 17.2 million people, of whom 8.8% had diabetes and had a 90-day death rate of 0.06%

  • QCOVID, comprised of 6 million people, 7% of whom had diabetes and an overall 97 day mortality rate of 0.07%.

The team also examined data on type 2 diabetes patients with severe COVID-19 from the UK COVID-19 Hospital Monitoring System (CHESS), which included 19,256 patients admitted to intensive care in England, of which 18 , 3% had diabetes.

The 30-day in-hospital death rate in this study was 26.4%.

They translated the mortality risk ratios associated with COVID-19 infection in people with diabetes into a “COVID age” which is the additional years of “risk of death” added to a person’s chronological age if they have diabetes.

Using the QCOVID dataset as an example, the results showed that the diabetes-related “COVID age” for someone aged 40 was 20.4 years; that would indicate that their “risk of mortality.” [for COVID-19] is similar to a 60 year old person without diabetes. “

The impact of diabetes on the risk of COVID-19 death decreased with age, such that a diabetes patient by the age of 50 had a COVID age of 16.4. This fell to 12.1 years for someone aged 60 and 8.1 years for someone aged 70, meaning the latter has the same risk of dying from COVID-19 as someone without diabetes who is 78 Years old.

Similar results were obtained when the team examined data from the OpenSAFELY study.

However, when they looked at the impact of diabetes on COVID-19 mortality risk in the CHESS dataset, it was less pronounced.

Just looking at diabetes is too easy, but it’s a simple marker for vaccination

Researchers acknowledge that “just taking age and diabetes status into account when assessing COVID-19-associated risks … is over-simplifying,” given factors such as body mass index (BMI), duration of diabetes, and blood sugar control also known to play a role.

However, taking these factors into account is “impractical for the introduction of vaccines at the population level”.

“The time-critical nature of the COVID-19 vaccination in the population requires pragmatic prioritization at group level. This is the approach that governments have initiated so far,” the team concludes.

This study was supported by Diabetes UK. Study author John M. Dennis is supported by an independent scholarship funded by Research England’s Expanding Excellence in England (E3) Fund and the NIHR Exeter Clinical Research Facility. McGovern is supported by the NIHR Exeter Clinical Research Facility.

Diabetologia. Published online February 8, 2021. Full text

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