Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults

J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3364-e3368. doi: 10.1210/clinem/dgab393. Epub 2021 Jun 1.


Context: Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear.

Objective: To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories.

Design setting and participants: We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020.

Main outcome measure(s): The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories.

Results: Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]).

Conclusions: Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.

Keywords: age; covid-19; diabetes; mortality.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • COVID-19 / virology
  • Diabetes Mellitus / physiopathology*
  • Female
  • France / epidemiology
  • Hospital Mortality / trends*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / isolation & purification*
  • Severity of Illness Index*