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The coronavirus disease 2019 (COVID-19) pandemic has occurred on a background of the diabetes pandemic.1 The former has had an immediate and obvious international impact, while the latter has been long recognised and continues to worsen. While of different aetiologies, both are significant public health challenges requiring commitment from governments, and partnership with public health practitioners, the healthcare workforce and communities.

COVID-19, caused by SARS-CoV-2 coronavirus, has spread rapidly throughout the world affecting more than three million to date with thousands dying (http://who.sprinklr.com/). In contrast, the prolonged diabetes pandemic1 affects an estimated 9.3% (463 million) of adults globally, and is projected to increase to 10.2% by 2030 and 10.9% by 2045.2 In New Zealand, diabetes affects 7% of those ≥15 years,3 and a considerable number of children aged <15 years.4 Notably, the rates of diabetes are higher among Māori, Pacific and South Asian compared with New Zealand Europeans,3 particularly those living in deprived situations. These groups are especially vulnerable to the far reaching impacts of the COVID-19 crisis, as they are disproportionately exposed to risk, which is potentially exacerbated through sudden loss of jobs and income, and reduced access to usual social support and healthcare.5

Diabetes is a risk factor for infection, more so in those with poor glycaemic control and those aged ≥60 years.6 Although there is no published evidence yet, those with diabetes are probably more likely to acquire COVID-19 infection. The risk of upper respiratory tract infection, lower tract respiratory infection or pneumonia is greater in those with diabetes compared with the general population.6 Furthermore, those with diabetes and infection have worse outcomes, including a higher risk of hospitalisation and death.

Most published clinical and epidemiological COVID-19 studies to date report on hospitalised patients. They consistently report that diabetes is a common co-morbidity with prevalence rates of up to 34%, and those with diabetes have more severe disease than those without.7 Among 7,162 US cases with near-complete data, 784 (10.9%) had diabetes, of whom over half were hospitalised and 148 (18.9%) required ICU admission.8 The proportion requiring ICU admission was similar to those with cardiovascular disease (20.4%), but higher than those with chronic lung disease (14.3%), or an immunocompromised condition (15.5%). In China, of 1,099 hospitalised COVID-19 cases, 81 (7.4%) had diabetes, of whom 34.6% developed severe disease, compared with 41/165 (24.8%) with hypertension, 10/27 (37.0%) with coronary artery disease, 67/261 (25.7%) with any co-existing disorder, and 106/838 (12.6%) in those with no co-existing disorder.9

Few reports include mortality data but they show a high proportion of COVID-19 deaths are in those with diabetes. In a Chinese study of 191 hospitalised COVID-19 cases, 19% had diabetes and 54 died, of whom 17 (31%) had diabetes.10 Similarly, in Italy 32% of 1,890 COVID-19 deaths had diabetes.11 Further, although there are methodological challenges with estimating the COVID-19 case fatality rate, such as accurately determining the most appropriate denominator, it is nevertheless higher among those with diabetes. In China, the case fatality rate among 44,672 confirmed cases was 2.8% overall, compared with 7.3% for diabetes, 10.5% for cardiovascular disease, 6.3% for chronic respiratory disease, 6.0% for hypertension and 5.6% for cancer.12

The reasons for poor outcomes from COVID-19 among those with diabetes are not fully understood. Current understanding is that it is multifactorial. Proposed risk factors include: uncontrolled blood glucose levels prior to and when infected with coronavirus; lack of, or reduced contact with usual diabetes healthcare professionals; and inappropriate discontinuation of a patient’s ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker). The latter has occurred due to the observation that the coronavirus binds to cells through ACE2. These medicines may increase ACE2 levels with the theoretical potential that there is increased uptake of the coronavirus. However, stopping these medications is more detrimental in most circumstances (www.nzssd.org.nz; www.easd.org; www.diabetes.org/coronavirus-covid-19).

The current infectious disease pandemic highlights that substantially greater attention needs to be given to diabetes, if we are to avoid unnecessary and inequitable outcomes from COVID-19. All steps need to be taken and maintained to protect this high-risk group through the nation-wide public health measures to prevent transmission, ensuring the influenza vaccination has been given, and undertaking workplace risk assessments. Furthermore, ensuring people with diabetes can continue to be regularly reviewed by their primary care or specialist diabetes health care providers is paramount, and patients need to be aware that there should be a very low threshold for the assessment of respiratory symptoms and coronavirus testing, particularly as the severity of COVID-19 infection may be obscured by a milder presentation.13 For those hospitalised, it is important to achieve good glycaemic control and strive for blood glucose readings of 4–10 mmol/L, and where possible involve diabetes specialist teams early, to prevent poor outcomes.13,14

Thus, in responding to the COVID-19 crisis, decisions and policies need to include diabetes, if health inequities are not to be exaggerated.5

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

All authors are members of the New Zealand Society for the Study of Diabetes (NZSSD) Executive Committee. Kirsten J Coppell, Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin; Rosemary M Hall, Endocrine, Diabetes and Research Centre, Wellington Regional Hospital, Wellington; Michelle Downie, Department of Medicine, Southland Hospital, Christchurch; Sonya K Fraser, Regional Diabetes Service, Waikato District Health Board, Hamilton; Michele Garrett, Community and Long Term Conditions Directorate, Auckland District Health Board, Auckland; Craig A Jefferies, Starship Children’s Health, Auckland; Timothy W Kenealy, South Auckland Clinical School, University of Auckland, Auckland; Roberta EH Milne, Whitiora Diabetes Service, Middlemore Hospital, Counties Manakau District Health Board, Auckland; Brandon J Orr-Walker, Whitiora Diabetes Service, Middlemore Hospital, Counties Manukau District Health Board, Auckland; Ryan G Paul, Regional Diabetes Service, Waikato District Health Board, Hamilton; Kate Smallman, Diabetes Foundation Aotearoa, Auckland; Helen J Snell, Diabetes and Endocrinology Service, MidCentral District Health Board, Palmerston North.

Acknowledgements

Correspondence

Kirsten J Coppell, Department of Medicine, University of Otago, PO Box 56, Dunedin 9054.

Correspondence Email

kirsten.coppell@otago.ac.nz

Competing Interests

Nil.

1. No authors listed. The diabetes pandemic. Lancet. 2011; 378:99.

2. Saeedi P, Petersohn I, Salpea P, et al.; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019; 157:107843. doi: 10.1016/j.diabres.2019.

3. Coppell KJ, Mann JI, Williams SM, et al. Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey. N Z Med J. 2013; 126:23–42.

4. Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012; 7(2):e32640.

5. No authors listed. Redefining vulnerability in the era of COVID-19. Lancet. 2020; 395:1089.

6. Carey IM, Critchley JA, DeWilde S, et al. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care. 2018; 41:513–21.

7. NZ Society for the Study of Diabetes. Prevalence of diabetes among populations with Covid-19. Unpublished review. NZ Society for the Study of Diabetes; 2020.

8. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:343–346. doi: 10.15585/mmwr.mm6912e2.

9. Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032. [Epub ahead of print]

10. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395:1054–62.

11. Istituto Superiore di Sanita: Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on April 20th, 2020. http://www.epicentro.iss.it/en/coronavirus/sars-cov-2-analysis-of-deaths [Accessed 23 April 2020].

12. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. doi: 10.1001/jama.2020.2648. [Epub ahead of print]

13. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020:e3319. doi: 10.1002/dmrr.3319.

14. Bode B, Garrett V, Messler J et al. Glycaemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. Journal of Diabetes Science and Technology, In press.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

The coronavirus disease 2019 (COVID-19) pandemic has occurred on a background of the diabetes pandemic.1 The former has had an immediate and obvious international impact, while the latter has been long recognised and continues to worsen. While of different aetiologies, both are significant public health challenges requiring commitment from governments, and partnership with public health practitioners, the healthcare workforce and communities.

COVID-19, caused by SARS-CoV-2 coronavirus, has spread rapidly throughout the world affecting more than three million to date with thousands dying (http://who.sprinklr.com/). In contrast, the prolonged diabetes pandemic1 affects an estimated 9.3% (463 million) of adults globally, and is projected to increase to 10.2% by 2030 and 10.9% by 2045.2 In New Zealand, diabetes affects 7% of those ≥15 years,3 and a considerable number of children aged <15 years.4 Notably, the rates of diabetes are higher among Māori, Pacific and South Asian compared with New Zealand Europeans,3 particularly those living in deprived situations. These groups are especially vulnerable to the far reaching impacts of the COVID-19 crisis, as they are disproportionately exposed to risk, which is potentially exacerbated through sudden loss of jobs and income, and reduced access to usual social support and healthcare.5

Diabetes is a risk factor for infection, more so in those with poor glycaemic control and those aged ≥60 years.6 Although there is no published evidence yet, those with diabetes are probably more likely to acquire COVID-19 infection. The risk of upper respiratory tract infection, lower tract respiratory infection or pneumonia is greater in those with diabetes compared with the general population.6 Furthermore, those with diabetes and infection have worse outcomes, including a higher risk of hospitalisation and death.

Most published clinical and epidemiological COVID-19 studies to date report on hospitalised patients. They consistently report that diabetes is a common co-morbidity with prevalence rates of up to 34%, and those with diabetes have more severe disease than those without.7 Among 7,162 US cases with near-complete data, 784 (10.9%) had diabetes, of whom over half were hospitalised and 148 (18.9%) required ICU admission.8 The proportion requiring ICU admission was similar to those with cardiovascular disease (20.4%), but higher than those with chronic lung disease (14.3%), or an immunocompromised condition (15.5%). In China, of 1,099 hospitalised COVID-19 cases, 81 (7.4%) had diabetes, of whom 34.6% developed severe disease, compared with 41/165 (24.8%) with hypertension, 10/27 (37.0%) with coronary artery disease, 67/261 (25.7%) with any co-existing disorder, and 106/838 (12.6%) in those with no co-existing disorder.9

Few reports include mortality data but they show a high proportion of COVID-19 deaths are in those with diabetes. In a Chinese study of 191 hospitalised COVID-19 cases, 19% had diabetes and 54 died, of whom 17 (31%) had diabetes.10 Similarly, in Italy 32% of 1,890 COVID-19 deaths had diabetes.11 Further, although there are methodological challenges with estimating the COVID-19 case fatality rate, such as accurately determining the most appropriate denominator, it is nevertheless higher among those with diabetes. In China, the case fatality rate among 44,672 confirmed cases was 2.8% overall, compared with 7.3% for diabetes, 10.5% for cardiovascular disease, 6.3% for chronic respiratory disease, 6.0% for hypertension and 5.6% for cancer.12

The reasons for poor outcomes from COVID-19 among those with diabetes are not fully understood. Current understanding is that it is multifactorial. Proposed risk factors include: uncontrolled blood glucose levels prior to and when infected with coronavirus; lack of, or reduced contact with usual diabetes healthcare professionals; and inappropriate discontinuation of a patient’s ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker). The latter has occurred due to the observation that the coronavirus binds to cells through ACE2. These medicines may increase ACE2 levels with the theoretical potential that there is increased uptake of the coronavirus. However, stopping these medications is more detrimental in most circumstances (www.nzssd.org.nz; www.easd.org; www.diabetes.org/coronavirus-covid-19).

The current infectious disease pandemic highlights that substantially greater attention needs to be given to diabetes, if we are to avoid unnecessary and inequitable outcomes from COVID-19. All steps need to be taken and maintained to protect this high-risk group through the nation-wide public health measures to prevent transmission, ensuring the influenza vaccination has been given, and undertaking workplace risk assessments. Furthermore, ensuring people with diabetes can continue to be regularly reviewed by their primary care or specialist diabetes health care providers is paramount, and patients need to be aware that there should be a very low threshold for the assessment of respiratory symptoms and coronavirus testing, particularly as the severity of COVID-19 infection may be obscured by a milder presentation.13 For those hospitalised, it is important to achieve good glycaemic control and strive for blood glucose readings of 4–10 mmol/L, and where possible involve diabetes specialist teams early, to prevent poor outcomes.13,14

Thus, in responding to the COVID-19 crisis, decisions and policies need to include diabetes, if health inequities are not to be exaggerated.5

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

All authors are members of the New Zealand Society for the Study of Diabetes (NZSSD) Executive Committee. Kirsten J Coppell, Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin; Rosemary M Hall, Endocrine, Diabetes and Research Centre, Wellington Regional Hospital, Wellington; Michelle Downie, Department of Medicine, Southland Hospital, Christchurch; Sonya K Fraser, Regional Diabetes Service, Waikato District Health Board, Hamilton; Michele Garrett, Community and Long Term Conditions Directorate, Auckland District Health Board, Auckland; Craig A Jefferies, Starship Children’s Health, Auckland; Timothy W Kenealy, South Auckland Clinical School, University of Auckland, Auckland; Roberta EH Milne, Whitiora Diabetes Service, Middlemore Hospital, Counties Manakau District Health Board, Auckland; Brandon J Orr-Walker, Whitiora Diabetes Service, Middlemore Hospital, Counties Manukau District Health Board, Auckland; Ryan G Paul, Regional Diabetes Service, Waikato District Health Board, Hamilton; Kate Smallman, Diabetes Foundation Aotearoa, Auckland; Helen J Snell, Diabetes and Endocrinology Service, MidCentral District Health Board, Palmerston North.

Acknowledgements

Correspondence

Kirsten J Coppell, Department of Medicine, University of Otago, PO Box 56, Dunedin 9054.

Correspondence Email

kirsten.coppell@otago.ac.nz

Competing Interests

Nil.

1. No authors listed. The diabetes pandemic. Lancet. 2011; 378:99.

2. Saeedi P, Petersohn I, Salpea P, et al.; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019; 157:107843. doi: 10.1016/j.diabres.2019.

3. Coppell KJ, Mann JI, Williams SM, et al. Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey. N Z Med J. 2013; 126:23–42.

4. Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012; 7(2):e32640.

5. No authors listed. Redefining vulnerability in the era of COVID-19. Lancet. 2020; 395:1089.

6. Carey IM, Critchley JA, DeWilde S, et al. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care. 2018; 41:513–21.

7. NZ Society for the Study of Diabetes. Prevalence of diabetes among populations with Covid-19. Unpublished review. NZ Society for the Study of Diabetes; 2020.

8. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:343–346. doi: 10.15585/mmwr.mm6912e2.

9. Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032. [Epub ahead of print]

10. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395:1054–62.

11. Istituto Superiore di Sanita: Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on April 20th, 2020. http://www.epicentro.iss.it/en/coronavirus/sars-cov-2-analysis-of-deaths [Accessed 23 April 2020].

12. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. doi: 10.1001/jama.2020.2648. [Epub ahead of print]

13. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020:e3319. doi: 10.1002/dmrr.3319.

14. Bode B, Garrett V, Messler J et al. Glycaemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. Journal of Diabetes Science and Technology, In press.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

The coronavirus disease 2019 (COVID-19) pandemic has occurred on a background of the diabetes pandemic.1 The former has had an immediate and obvious international impact, while the latter has been long recognised and continues to worsen. While of different aetiologies, both are significant public health challenges requiring commitment from governments, and partnership with public health practitioners, the healthcare workforce and communities.

COVID-19, caused by SARS-CoV-2 coronavirus, has spread rapidly throughout the world affecting more than three million to date with thousands dying (http://who.sprinklr.com/). In contrast, the prolonged diabetes pandemic1 affects an estimated 9.3% (463 million) of adults globally, and is projected to increase to 10.2% by 2030 and 10.9% by 2045.2 In New Zealand, diabetes affects 7% of those ≥15 years,3 and a considerable number of children aged <15 years.4 Notably, the rates of diabetes are higher among Māori, Pacific and South Asian compared with New Zealand Europeans,3 particularly those living in deprived situations. These groups are especially vulnerable to the far reaching impacts of the COVID-19 crisis, as they are disproportionately exposed to risk, which is potentially exacerbated through sudden loss of jobs and income, and reduced access to usual social support and healthcare.5

Diabetes is a risk factor for infection, more so in those with poor glycaemic control and those aged ≥60 years.6 Although there is no published evidence yet, those with diabetes are probably more likely to acquire COVID-19 infection. The risk of upper respiratory tract infection, lower tract respiratory infection or pneumonia is greater in those with diabetes compared with the general population.6 Furthermore, those with diabetes and infection have worse outcomes, including a higher risk of hospitalisation and death.

Most published clinical and epidemiological COVID-19 studies to date report on hospitalised patients. They consistently report that diabetes is a common co-morbidity with prevalence rates of up to 34%, and those with diabetes have more severe disease than those without.7 Among 7,162 US cases with near-complete data, 784 (10.9%) had diabetes, of whom over half were hospitalised and 148 (18.9%) required ICU admission.8 The proportion requiring ICU admission was similar to those with cardiovascular disease (20.4%), but higher than those with chronic lung disease (14.3%), or an immunocompromised condition (15.5%). In China, of 1,099 hospitalised COVID-19 cases, 81 (7.4%) had diabetes, of whom 34.6% developed severe disease, compared with 41/165 (24.8%) with hypertension, 10/27 (37.0%) with coronary artery disease, 67/261 (25.7%) with any co-existing disorder, and 106/838 (12.6%) in those with no co-existing disorder.9

Few reports include mortality data but they show a high proportion of COVID-19 deaths are in those with diabetes. In a Chinese study of 191 hospitalised COVID-19 cases, 19% had diabetes and 54 died, of whom 17 (31%) had diabetes.10 Similarly, in Italy 32% of 1,890 COVID-19 deaths had diabetes.11 Further, although there are methodological challenges with estimating the COVID-19 case fatality rate, such as accurately determining the most appropriate denominator, it is nevertheless higher among those with diabetes. In China, the case fatality rate among 44,672 confirmed cases was 2.8% overall, compared with 7.3% for diabetes, 10.5% for cardiovascular disease, 6.3% for chronic respiratory disease, 6.0% for hypertension and 5.6% for cancer.12

The reasons for poor outcomes from COVID-19 among those with diabetes are not fully understood. Current understanding is that it is multifactorial. Proposed risk factors include: uncontrolled blood glucose levels prior to and when infected with coronavirus; lack of, or reduced contact with usual diabetes healthcare professionals; and inappropriate discontinuation of a patient’s ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker). The latter has occurred due to the observation that the coronavirus binds to cells through ACE2. These medicines may increase ACE2 levels with the theoretical potential that there is increased uptake of the coronavirus. However, stopping these medications is more detrimental in most circumstances (www.nzssd.org.nz; www.easd.org; www.diabetes.org/coronavirus-covid-19).

The current infectious disease pandemic highlights that substantially greater attention needs to be given to diabetes, if we are to avoid unnecessary and inequitable outcomes from COVID-19. All steps need to be taken and maintained to protect this high-risk group through the nation-wide public health measures to prevent transmission, ensuring the influenza vaccination has been given, and undertaking workplace risk assessments. Furthermore, ensuring people with diabetes can continue to be regularly reviewed by their primary care or specialist diabetes health care providers is paramount, and patients need to be aware that there should be a very low threshold for the assessment of respiratory symptoms and coronavirus testing, particularly as the severity of COVID-19 infection may be obscured by a milder presentation.13 For those hospitalised, it is important to achieve good glycaemic control and strive for blood glucose readings of 4–10 mmol/L, and where possible involve diabetes specialist teams early, to prevent poor outcomes.13,14

Thus, in responding to the COVID-19 crisis, decisions and policies need to include diabetes, if health inequities are not to be exaggerated.5

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

All authors are members of the New Zealand Society for the Study of Diabetes (NZSSD) Executive Committee. Kirsten J Coppell, Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin; Rosemary M Hall, Endocrine, Diabetes and Research Centre, Wellington Regional Hospital, Wellington; Michelle Downie, Department of Medicine, Southland Hospital, Christchurch; Sonya K Fraser, Regional Diabetes Service, Waikato District Health Board, Hamilton; Michele Garrett, Community and Long Term Conditions Directorate, Auckland District Health Board, Auckland; Craig A Jefferies, Starship Children’s Health, Auckland; Timothy W Kenealy, South Auckland Clinical School, University of Auckland, Auckland; Roberta EH Milne, Whitiora Diabetes Service, Middlemore Hospital, Counties Manakau District Health Board, Auckland; Brandon J Orr-Walker, Whitiora Diabetes Service, Middlemore Hospital, Counties Manukau District Health Board, Auckland; Ryan G Paul, Regional Diabetes Service, Waikato District Health Board, Hamilton; Kate Smallman, Diabetes Foundation Aotearoa, Auckland; Helen J Snell, Diabetes and Endocrinology Service, MidCentral District Health Board, Palmerston North.

Acknowledgements

Correspondence

Kirsten J Coppell, Department of Medicine, University of Otago, PO Box 56, Dunedin 9054.

Correspondence Email

kirsten.coppell@otago.ac.nz

Competing Interests

Nil.

1. No authors listed. The diabetes pandemic. Lancet. 2011; 378:99.

2. Saeedi P, Petersohn I, Salpea P, et al.; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019; 157:107843. doi: 10.1016/j.diabres.2019.

3. Coppell KJ, Mann JI, Williams SM, et al. Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the 2008/09 Adult Nutrition Survey. N Z Med J. 2013; 126:23–42.

4. Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012; 7(2):e32640.

5. No authors listed. Redefining vulnerability in the era of COVID-19. Lancet. 2020; 395:1089.

6. Carey IM, Critchley JA, DeWilde S, et al. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care. 2018; 41:513–21.

7. NZ Society for the Study of Diabetes. Prevalence of diabetes among populations with Covid-19. Unpublished review. NZ Society for the Study of Diabetes; 2020.

8. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:343–346. doi: 10.15585/mmwr.mm6912e2.

9. Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032. [Epub ahead of print]

10. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395:1054–62.

11. Istituto Superiore di Sanita: Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on April 20th, 2020. http://www.epicentro.iss.it/en/coronavirus/sars-cov-2-analysis-of-deaths [Accessed 23 April 2020].

12. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. doi: 10.1001/jama.2020.2648. [Epub ahead of print]

13. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020:e3319. doi: 10.1002/dmrr.3319.

14. Bode B, Garrett V, Messler J et al. Glycaemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. Journal of Diabetes Science and Technology, In press.

Contact diana@nzma.org.nz
for the PDF of this article

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