Large international study: at least 2 servings of dairy per day associated with lower prevelance of metabolic syndrome

Bhavadharini, B.,  et al. (2020). Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries| BMJ Open Diabetes Research and Care| 8 | e000826|  doi: 10.1136/bmjdrc-2019-000826

Research published in the BMJ Open Diabetes Research & Care, reports that higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. The authors recommend their findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

Abstract

Objective Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study.

Methods The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes).

Results In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone, or consumed jointly with low fat dairy, were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS. In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension and diabetes. Directionally similar associations were found for whole fat dairy versus each outcome.

Conclusions Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

BMJ Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries 

In the news:

Nursing Times Two servings a day of dairy linked to lower risk of diabetes and hypertension

The Telegraph Full fat dairy products help cut risk of obesity and diabetes, study suggests

NHS study: “demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19” #covid19rftlks

NHS England | May 2020 | NHS expands offer of help to people with diabetes during coronavirus outbreak

NHS England have published the findings of new NHS research which looked at data from 263,830 patients registered with a a General Practice in England on February 19th 2020 with a recorded diagnosis of Type 1, and 2,864,670 patients with a diagnosis of Type 2 diabetes.

The population cohort study assessing risks of in-hospital death using Multivariate logistic regression to examine diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.

The world-leading studies reveal that people living with type 1 diabetes are at three and a half times the risk, and people living with type 2 are at double the risk of dying in hospital with the virus, compared to people without diabetes.

The strongest risk factor for dying with the virus is age, and people with type 1 diabetes are on average younger than people with type 2 diabetes.

Overall, 7,466 of those who died in hospitals in England had type 2 and 365 who died had type 1 diabetes, and the research suggests that the threat for those under 40 with type 1 or type 2 diabetes is very low, with no recorded deaths in those under 20.

It is thought that the risk to people with diabetes and the virus is in line with the extra risk seen in other infectious conditions such as pneumonia.

The study also shows that in people with both type 1 and type 2 diabetes, even when all other known factors are taken into account, higher blood glucose levels and obesity are linked to higher risk (Source: NHS England).

Abstract
Background
Although diabetes has been associated with COVID-19 mortality, the absolute and relative risks for Type 1 and Type 2 diabetes are unknown.
Methods
A population cohort study assessing risks of in-hospital death with COVID-19 between 1stMarch and 11th May 2020, including individuals registered with a General Practice in England and alive on February 19th 2020.
Multivariate logistic regression examined diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.
Findings
Of the 61,414,470 individuals registered, 263,830 (0∙4%) had a recorded diagnosis of Type 1 and 2,864,670 (4∙7%) of Type 2 diabetes. There were 23,804 COVID-19 related deaths. One third occurred in people with diabetes: 7,466 (31∙4%) with Type 2 and 365 (1∙5%) with Type 1 diabetes. Crude mortality rates per 100,000 persons over the 72 days for the overall population and for those with Type 1 and Type 2 diabetes were 38∙8
, 138∙3, and 260∙6 respectively. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1 and Type 2 diabetes had 3∙50 and 2∙03 times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes, attenuated to 2∙86 and 1∙81 respectively when also adjusted for previous hospital admissions with coronary heart disease, cerebrovascular disease or heart failure.
Interpretation
This nationwide analysis in England demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.
Funding
NHS England & Improvement and Public Health England.


Research in context
Evidence before this study

From March 2020, we performed weekly searches of PubMed and MedRxiv using the terms COVID-19, SARSCoV-2, coronavirus,SARS virus and diabetes. Studies from China, Italy, the USA and the UK have suggested that people with diabetes have higher risks of more severe outcomes with COVID-19, including death. One population-based UK study reported a higher risk of COVID-19 related death in those with diabetes after
adjustment for demographic factors and other comorbidities. However, none of these studies have assessed differences in risk by type of diabetes.
Added value of this study
This is the largest COVID-19 related study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risks of death in hospital with COVID-19 by type of diabetes, adjusting for key confounders. It demonstrates that one third of all deaths in-hospital with COVID-19 occur in people with diabetes. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1
and Type 2 diabetes had 3.50 and 2.03 times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes. These relative odds were attenuated to 2.86 and 1.81 respectively when also adjusted for previous hospital admissions with cardiovascular comorbidities.
Implications of all the available evidence
People with diabetes are at higher risk of COVID-19 related death, and those with Type 1 diabetes are at higher risk than those with Type2 diabetes. These insights are important in both understanding the pathophysiological mechanisms underlying the determinants of more severe outcomes with COVID-19, and in informing potential clinical and public health responses to the pandemic.

Read the full paper

In the news:

The Guardian Covid-19: people with type 1 diabetes more likely to die than those with type 2 – study

Metro Why are people with diabetes at higher risk of dying from coronavirus?

Rapid Review: Diabetic retinopathy screening during the COVID-19 pandemic

Ahmad, E., Davies, M.J. & Khunti, K. | Centre for Evidence-Based Medicine| May 2020 | Diabetic retinopathy screening during the COVID-19 pandemic

A new rapid review from tbeCentre for Evidence-Based Medicine considers the question

People with diabetes (PWD) are included in the group at increased risk of severe illness from coronavirus (COVID-19) and have been advised to observe stringent social distancing measures.(1)  This creates a difficult situation for PWD and their Health Care Providers (HCP) as PWD require an annual review including retinal screening as part of their screening for complications, which involves a physical visit to a community or hospital facility or an eye clinic.

  • How can we help stratify annual retinal screening programmes for people with diabetes (PWD) during the COVID-19 pandemic?
  • Can we do remote retinal review for PWD?
  • What can we do to control the risk factors for development or progression of diabetic retinopathy during the COVID-19 pandemic?
  • Is hydroxycholoroquine safe to use in individuals with diabetic retinopathy?

Rapid Review: Diabetic retinopathy screening during the COVID-19 pandemic

 

 

Coronavirus: A quarter of COVID-19 patients who died in England had diabetes

Sky News |May 2020| Coronavirus: A quarter of COVID-19 patients who died in England had diabetes

Figures released by NHS England show that 1 in 4 of COVID-19 patients who have died in England had diabetes. Although the statistics do not distinguish between type 1 and type 2, they show that of the 22,332 people who died since 31 March, 5,873 (26%) of them were people with diabetes.

Full news story from Sky

Diabetes UK have also produced this release:

We know many of you will have seen the news yesterday reporting on the new statistic published that shows that 26% of those who have died from coronavirus in England had diabetes. We wanted to give you as much information as we currently have about this data, as well as update you on what we’re doing to support you.

[Updated 4pm 15 May 2020]

Read the [Diabetes UK] Latest statistic on coronavirus deaths in England

See also ITV News One in four coronavirus patients who died in England’s hospitals had diabetes

The Guardian Quarter of Covid-19 deaths in English hospitals were of diabetics

Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes #covid19rftlks

Zhu, L., et al. (2020). Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism.

Journal Cell Metabolism has published research conducted in Wuhan which has found  evidence to suggest that blood glucose might give protection to those with type 2 diabetes. Zhu et al, 2020, studied more than 7000 patients with COVID-19 (almost 1000 of whom had type 2 diabetes).  Those with type 2 diabetes (T2D) had significantly increased medical interventions and mortality risk. But among the patients with T2D, those with well-controlled blood glucose regulation (upper limit less than or equal to 10 mmol/L) fared much better than those with poorly controlled blood glucose (upper limit more than 10 mmol/L). These findings provide clinical evidence correlating more proper blood glucose control with improved outcomes in patients with COVID-19.

Maintaining good blood sugar control could improve COVID-19 health outcomes of people with diabetes who become infected with the disease, researchers have said.

Highlights

A cohort of 7,337 COVID-19 patients with or without diabetes was retrospectively studied

Diabetes status increased the need for medical interventions during COVID-19

Diabetes status increased the mortality risk of patients with COVID-19

Well-controlled blood glucose correlated with improved outcomes in infected patients

Summary

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D. (Source: Zhu et al, 2020)

See also:

Diabetes UK Controlling blood sugar levels could improve COVID-19 health outcomes

Practical recommendations for the management of diabetes in patients with COVID-19 #covid19rftlks

The Lancet Diabetes & Endocrinology has published a viewpoint that outlines a number of practical recommendations for the management of diabetes in patients with COVID-19.

Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20–50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. The piece aims to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.

Read the full piece