Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19

Abstract

Diabetes and obesity are highly prevalent among hospitalized patients with coronavirus disease 2019 (COVID-19), but little is known about their contributions to early COVID-19 outcomes. We tested the hypothesis that diabetes is a risk factor for poor early outcomes, after adjustment for obesity, among a cohort of patients hospitalized with COVID-19. RESEARCH DESIGN AND METHODS We used data from the Massachusetts General Hospital (MGH) COVID-19 Data Registry of patients hospitalized with COVID-19 between 11 March 2020 and 30 April 2020. Primary outcomes were admission to the intensive care unit (ICU), need for mechanical ventilation, and death within 14 days of presentation to care. Logistic regression models were adjusted for demographic characteristics, obesity, and relevant comorbidities. RESULTS Among 450 patients, 178 (39.6%) had diabetesdmostly type 2 diabetes. Among patients with diabetes versus patients without diabetes, a higher proportion was admitted to the ICU (42.1% vs. 29.8%, respectively, P 5 0.007), required mechanical ventilation (37.1% vs. 23.2%, P 5 0.001), and died (15.9% vs. 7.9%, P 5 0.009). In multivariable logistic regression models, diabetes was associated with greater odds of ICU admission (odds ratio 1.59 [95% CI 1.01-2.52]), mechanical ventilation (1.97 [1.21-3.20]), and death (2.02 [1.01-4.03]) at 14 days. Obesity was associated with greater odds of ICU admission (2.16 [1.20-3.88]) and mechanical ventilation (2.13 [1.14-4.00]) but not with death. CONCLUSIONS Among hospitalized patients with COVID-19, diabetes was associated with poor early outcomes, after adjustment for obesity. These findings can help inform patient-centered care decision making for people with diabetes at risk for COVID-19. Diabetes is one of the most common chronic conditions in the U.S., currently estimated to affect 34.2 million people (10.5% of the U.S. population) (1). In addition to the well-documented adverse health outcomes associated with this disease, diabetes has also emerged as a commonly reported risk factor among people hospitalized with coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus (2-7). Following initial reports of COVID-19 in Washington state (January 2020) (8), COVID-19 has spread rapidly and resulted in .3.0 million cases and nearly 135,000 deaths in the U.S.

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

“…Fasting glucose was recorded from standard morning fasting blood biochemistry. The median length of hospital stay for nonsurvivors in our cohort was 17 days (interquartile range [IQR] [14][15][16][17][18][19][20][21][22], and patients often suffered sepsis and multiple organ injury during the 2nd week after admission according to our observations and a recent report (5). These conditions resulted in dramatic increases in glucose.…”

“…Optimal in-hospital glycemic control is associated with better prognosis for COVID-19 patients with diabetes (13). Recent evidence indicated that diabetes status and admission fasting glucose were associated with poor prognosis of COVID-19 patients (14)(15)(16)(17)(18). We observed a significant association between diabetes and mortality after adjusting for age and sex.…”

Proportion of newly diagnosed diabetes in COVID‐19 patients: A systematic review and meta‐analysis

“…type 2 diabetes). 27 The quality of studies was either fair or good, with most (n = 6; 75%) studies being of good quality. With a total of 3711 COVID-19 patients with 492 cases of newly diagnosed diabetes from eight studies, the random effects meta-analysis estimated a pooled proportion of 14.4% (95% CI: 5.9%-25.8%) with a high degree of heterogeneity (I 2 : 98.6%, P < .001) ( Figure 1).…”

Clinical characteristics and short-term prognosis of in-patients with diabetes and COVID-19: A retrospective study from an academic center in Belgium

“…Ten patients with diabetes and 32 patients without diabetes died from COVID-19, yielding comparable in-hospital CFRs in both groups (15.6% versus 25.0%, p 0.194) ( Table 2 ). The median length of hospital stay in survivors was longer in patients with diabetes than in patients without diabetes (13 [8–17] days vs. 9 [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ] days, p 0.007). In the overall cohort, multivariate analysis found that cognitive impairment (HR 3.84, CI 1.50–9.86, p 0.005), CVD (HR 3.54, CI 1.60–7.82, p 0.002) and extended to critical pneumonia (>25% lung surface) on admission (HR 9.39, CI 2.89–30.4, p < 0.0001) were risk factors/markers associated with in-hospital death ( Table 3 ).…”

“…The case fatality rate (CFR) of COVID-19 in the general population varies from 2 to 15% in severe cases [ [7] , [8] , [9] ], to more than 20% and even 50% in critical cases [ [10] , [11] , [8] , [9] ]. Diabetes increases the odds of in-hospital death by 2 to 3-fold [ 8 , 9 , 12 , 13 ].…”