For many months, it’s been known that people with diabetes — both type 1 and type 2 — are at a higher risk for poor outcomes related to COVID-19, including hospitalization, admission to an intensive care unit (ICU) and death. It has also been known that like the general population without diabetes, these risks apply disproportionately to older adults with diabetes.
Because of the increased risk of death and other poor outcomes related to COVID-19 that comes with being older, it makes sense to prioritize older adults for COVID-19 vaccines — regardless of whether they have diabetes. But whether younger adults with diabetes should have priority access to vaccines has been a trickier question, in part because there haven’t been many studies looking at the question of whether nonelderly adults with diabetes, in particular, have worse outcomes related to COVID-19.
Now, a new study shows convincingly that middle-aged adults with type 2 diabetes have a higher risk of death from COVID-19 — and should, logically, be a priority group for vaccination.
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Higher “COVID age” in people with type 2
The new study, accepted for publication by the journal Diabetologia, used a somewhat creative technique to calculate whether people with type 2 diabetes have an increased risk of dying from COVID-19.
By comparing COVID-19 outcomes at different ages in people with or without diabetes, researchers came up with a “COVID age” representing the risk of dying from COVID-19 in people with type 2 — a number equivalent to the age at which they would have the same risk of dying if they didn’t have diabetes. In other words, if your risk of dying is higher than that of someone your age without diabetes, then your “COVID age” is higher.
The researchers showed that for people with type 2 diabetes ages 30 and older, at younger ages, their “COVID age” was quite a bit higher than their actual age. But as people with type 2 got older, their “COVID age” got closer to their actual age — showing that their risk of dying from COVID-19 wasn’t as elevated compared to people the same age without diabetes. People with type 2 had an elevated risk of death at all ages though, just to different degrees. And older people with type 2 had much higher risk of dying from COVID-19 than younger people with type 2 — just not as much higher compared with the overall risk in their age group.
The researchers found, for example, that a person with type 2 who is 40 years old had a “COVID age” of 60 — meaning the same risk of death as a 60-year-old without diabetes. This “gap” of over 20 years at age 40 got smaller as people got older. A person with type 2 who is 50 years old had a “COVID age” of 66, while someone with type 2 who is 60 years old had a “COVID age” of 72. At age 70, a person with type 2 had a “COVID age” of 78; at age 80, they had a “COVID age” of 85; and at age 90 they had a “COVID age” of only 91.
Since younger people with type 2 diabetes have a risk of dying from COVID-19 that’s similar to the risk of older people without diabetes, it makes sense to give middle-aged people with type 2 priority access to COVID-19 vaccines, the researchers concluded.
Different policies in different U.S. states
While some countries are giving nonelderly people with type 2 diabetes priority access to COVID-19 vaccines — including Britain and Germany — the researchers note that this isn’t a consistent practice. And in the United States, each state has its own rules for vaccine eligibility and distribution — rules that may change as the availability of vaccines changes, or as more becomes known about risks related to COVID-19 for certain groups.
Another reason to consider prioritizing vaccine access for middle-aged people with type 2 is that they’re more likely to be working than older people, potentially creating more opportunity to be exposed to COVID-19 in the workplace. Regardless of how states prioritize vaccine access, the researchers recommend that people with type 2 get vaccinated as soon as they can.
At the same time, you shouldn’t be overly worried about dying from COVID-19, the researchers write — even as you take steps to reduce your risk. With or without diabetes, they emphasize, a younger person is at lower risk for death if they develop COVID-19 than an older person.
Want to learn more about coronavirus and diabetes? Read our latest COVID-19 updates.