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Among 337,802 participants in the UK Biobank prospective cohort study, there were 649 cases of COVID-19 that were serious enough to warrant hospital admission between March 16, 2020, and April 26, 2020. Multivariable adjusted analyses demonstrated an increased risk of COVID-19 in persons who had undiagnosed diabetes at baseline (defined as A1C ≥6.5%) and in those with poorly controlled diabetes (defined as A1C ≥8.6%). Relative risk was 2.68 in those with undiagnosed diabetes at baseline and 1.91 in those with poorly controlled diabetes.
With increasing A1c—even within the normal range—the risk of COVID-19 increased progressively. Regulation of blood glucose may have a significant role in immune response to COVID-19.
This abstract is available on the publisher's site.
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.
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).
In this large community-based sample, higher levels of A1C within the normal range were 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.