Approved research

Analysis of diabetes mellitus and cardiometabolic disease in relation to severe outcomes of COVID-19: A UK Biobank study

Lay summary

In this study, we will evaluate data from people with COVID-19 infection in relation to diabetes (type 1 and 2), high blood pressure, obesity and cardiovascular disease. We intend to study the characteristics of people with COVID-19 with particular reference to diabetes, high blood pressure, obesity and cardiovascular disease and the wealth of biomarker data in the UK Biobank. We will specifically investigate associations of interest based on the current understanding of people who are at risk. This includes clinical, biochemical and imaging biomarkers, background drug treatment and participants' demographics such as ethnicity. We ultimately aim to develop a statistical model which will predict those who are at high risk of having adverse outcomes related to COVID-19 infection; resulting in the development of a robust tool that can be used for risk stratification of severe disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus which results in COVID-19, primarily a respiratory illness. It is highly contagious and on 11th March the World Health Organisation labelled COVID-19 as a global pandemic. At time of writing, the number of deaths stands at more than 170,000 worldwide and unfortunately this figure is increasing exponentially. COVID-19 is a great threat to people's physical, mental and economic well-being. According to available clinical data, up to 30% of the severe (requiring hospitalisation) COVID!19 patients have diabetes and hypertension and up to 15% have coronary heart disease. In addition, within the last week media reports suggest the majority of admissions to intensive care units in the UK for mechanical ventilation are people who are overweight or obese and Black, Asian and minority ethnic (BAME) people are disproportionately affected. Diabetes, cardiovascular disease and obesity seems to confer a much higher risk of severe COVID-19 than even chronic respiratory disease. It has also been suggested that diabetes medication including angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and thiazolidinediones may result in increased susceptibility or severity of COVID-19 or are even beneficial. If as expected this study demonstrates that people with diabetes and cardiovascular disease are at higher risk of severe COVID-19, these data will be utilised to develop a multi-state disease progression model for the prediction of disease severity and for the accurate identification/quantification of risk factors. Understanding the differences in risk of people with diabetes is paramount in developing effective public health and treatment strategies. The potential societal benefits are huge.