Diabetes increases severe COVID-19 outcomes primarily in younger adults Age and diabetes in COVID-19 severity.

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Diabetes is reported as a risk factor for severe COVID-19, but whether this risk is similar in all categories of age remains unclear.To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories.We conducted a retrospective observational cohort study of 6,314 consecutive patients hospitalized for COVID-19 between February and June 30 2020, and follow-up recorded until 30 September 2020, in the Paris metropolitan area, France.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.Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (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 in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 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 under 50 (HR 1.81 [1.14-2.87]).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.

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Authors: Marc Diedisheim, Etienne Dancoisne, Jean-François Gautier, Etienne Larger, Emmanuel Cosson, Bruno Fève, Philippe Chanson, Sébastien Czernichow, Sopio Tatulashvili, Marie-Laure Raffin-Sanson, Muriel Bourgeon, Christiane Ajzenberg, Agnès Hartemann, Christel Daniel, Thomas Moreau, Ronan Roussel, Louis Potier


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