Impact of Prediabetes and Type-2 Diabetes on Outcomes in Patients with COVID-19

Abstract

Introduction. The true impact of prediabetes and type-2 diabetes in patients with COVID-19 remains unknown, with studies thus far providing conflicting evidence. Methods. This is a single-center retrospective observational study involving 843 hospitalized patients with SARS-CoV-2 infection. Primary outcomes, mortality, and mechanical ventilation use were compared among the three groups: control, prediabetes, and type-2 diabetes. Binomial regression analysis was used to determine predictors of mortality and mechanical ventilation requirement. Results. Age was a significant predictor of mortality. On stratifying our patients based on their age, older patients aged 55 years and above had no difference in mortality or mechanical ventilation requirement among the three groups of control, prediabetes, and type-2 diabetes. However, among the younger population aged less than 55 years, patients with type-2 diabetes had significantly higher mortality as compared with patients in control and prediabetes groups (27% vs 12.5% vs 9%, p 0.025 ). Additionally, newly diagnosed type-2 diabetes patients demonstrated lower mortality rate in comparison to previously known type-2 diabetes patients (18% vs 40%, p 0.005 ). Outcomes in the prediabetes group were similar to that in the control group. Admission hyperglycemia was associated with higher mortality regardless of diabetes status. Conclusion. In older patients aged 55 years and above, status of type-2 diabetes does not influence their mortality. However, in younger patients aged less than 55 years, the presence of type-2 diabetes is an important driver of mortality. Newly diagnosed type-2 diabetes, in comparison with previously diagnosed type-2 diabetes, may have better survival. Presence of prediabetes did not affect outcomes in patients with COVID-19 infection.

Glycemic Characteristics and Clinical Outcomes in Patients with COVID-19 Admitted to Referral Shahid Sayad Shirazi Hospital in Gorgan, North of Iran

“…SARS-CoV-2, as the causative agent of the COVID-19 disease, became a public health emergency of international concern soon after the start of the outbreak in Wuhan, China. DM has emerged as an important risk factor for more severe COVID-19 illness and death [ 13 , 14 ]. Our study aimed to investigate the glycemic characteristics and clinical outcomes in patients with COVID-19.…”

A prospective study of the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody responses among patients with predominantly non-severe COVID-19

“…However, a control group was not available in that study [3] . A single-centre retrospective study in the United States showed the rate of severe COVID-19 was not increased in patients with prediabetes, where prediabetes was defined by HbA1c checked anytime within one year of admission [4] . On the contrary, a recent Mexican retrospective cohort study analysing COVID-19 patients with HbA1c checked on admission based on attending physicians’ discretion showed that prediabetes was associated with a higher risk of severe COVID-19 [5] .…”

“…reported a relatively high rate of severe adverse outcomes among 102 COVID-19 patients with prediabetes in India [3] . Results from case-control studies were mixed: a retrospective cohort of 843 COVID-19 patients in the United States reported no significant difference in outcomes in 110 patients with prediabetes compared with control [4] , while a Mexican cohort of 317 COVID-19 patients [5] and a selected cohort of 240 migrant workers in Singapore [6] showed that prediabetes conferred a greater risk of severe COVID-19. These were patients with more severe diseases or from a selected sub-population.…”