Our analysis shows that the population incidence for DKA hospitalizations in the U.S. continues to increase, but the mortality from this condition has significantly decreased, indicating advances in early diagnosis and better inpatient care. Despite decreases in the length of stay, the costs of hospitalizations have increased significantly, indicating opportunities for value-based care intervention in this vulnerable population.
Purpose Infectious diseases are more frequent and can be associated with worse outcomes in patients with diabetes. The aim of this study was to systematically review and conduct a meta-analysis of the available observational studies reporting the effect of diabetes on mortality among hospitalized patients with COVID-19. Methods The Medline, Embase, Google Scholar, and medRxiv databases were reviewed for identification of eligible studies. A random effects model meta-analysis was used, and I 2 was utilized to assess the heterogeneity. In-hospital mortality was defined as the endpoint. Sensitivity, subgroup, and meta-regression analyses were performed. Results A total of 18,506 patients were included in this meta-analysis (3713 diabetics and 14,793 non-diabetics). Patients with diabetes were associated with a higher risk of death compared with patients without diabetes (OR 1.65; 95% CI 1.35–1.96; I 2 77.4%). The heterogeneity was high. A study-level meta-regression analysis was performed for all the important covariates, and no significant interactions were found between the covariates and the outcome of mortality. Conclusion This meta-analysis shows that that the likelihood of death seems to be higher in diabetic patients hospitalized with COVID-19 compared with non-diabetic patients. Further studies are needed to assess whether this association is independent or not, as well as to investigate the role of adequate glycemic control prior to infection with COVID-19. Electronic supplementary material The online version of this article (10.1007/s42000-020-00246-2) contains supplementary material, which is available to authorized users.
Context Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there is little data focusing on outcomes in people with type 1 diabetes. Objective The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. Design An observational multi-site cross-sectional study was performed. Diabetes providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between HbA1c, age, and comorbidities and hospitalization. Setting Cases were submitted from 52 US sites between March and August 2020. Patients or Other Participants Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. Interventions None. Main Outcome Measures Hospitalization for COVID-19 infection. Results A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and five patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (OR 1.42, 95% CI 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. Conclusions Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.
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