Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

Abstract

Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients. RESEARCH DESIGN AND METHODS This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality. RESULTS Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95; P 5 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35; P 5 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38; P 5 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55; P 5 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42; P 5 0.04) but not with type 2 diabetes (P 5 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L; P 5 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase; P 5 0.007) as well as treatments with insulin (aHR 3.05, 95% CI 1.57-5.95; P 5 0.001) and b-blockers (aHR 3.20, 95% CI 1.50-6.60; P 5 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92; P 5 0.042). CONCLUSIONS Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq

“…study, patients with COVID-19 infection using insulin for treatment of DM were associated with poor prognosis compared to non-insulin users. [ 24 ] Consistent with our results , a recent study conducted in Lombardo found that treatment with insulin and lower lymphocyte count were associated with higher mortality, even after adjustment for sex and age, whereas the use of metformin or DPP-4 inhibitors were associated with a lower mortality rate [ 25 ].…”

Vitamin D deficiency, secondary hyperparathyroidism and respiratory insufficiency in hospitalized patients with COVID-19

“…Some of the enrolled patients had been already involved in other COVID-19 studies evaluating endpoints which were different from the present study [31][32][33][34][35].…”

COVID-19 and diabetes mellitus: from pathophysiology to clinical management

“…In a retrospective case-control study from northern Italy, sitagliptin treatment during hospitalization was associated with reduced mortality and improved clinical outcomes in such patients 89 . Another Italian case series described the association between DPP4i treatment and a statistically significantly reduced mortality; however, this result was based on only 11 patients (of whom one died) 90 . However, DPP4i treatment was associated with worse outcomes (mortality results were not presented) in 27 patients with T2DM treated with DPP4is than in 49 treated with other glucose-lowering medications 87 .…”