Relationship between obesity and severe COVID‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Abstract

Aim To assess the relationship between body mass index (BMI) classes and early COVID‐19 prognosis in inpatients with type 2 diabetes (T2D). Methods From the CORONAvirus‐SARS‐CoV‐2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID‐19–related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status. Results Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5‐24.9 kg/m 2 , reference group), 726 (36.9%) overweight (25‐29.9 kg/m 2 ) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30‐34.9 kg/m 2 ) and 314 (16.0%) with class II/III obesity (≥35 kg/m 2 ). In a multivariable‐adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05‐2.59]), class I (OR 1.93 [1.19‐3.14]) and class II/III obesity (OR 1.98 [1.11‐3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years. Conclusions Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID‐19. Importantly, the deleterious impact of obesity on COVID‐19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Obesity with or without T2D has been associated with higher rates of hospitalization and an increased severity of illness, in multiple retrospective observational analyses. Investigators in the French CORONADO trial observed that the risk of mechanical ventilation or death (the primary composite outcome) by day 7 of hospital admission in 1,965 people with SARS-CoV-2 infection and T2D rose progressively with increasing BMI, with odds ratios of 1.65, 1.93, and 1.98, for overweight, class I, and class II/III obesity, respectively ( Smati et al., 2021 ). Nevertheless, increasing BMI alone was not a risk factor for mortality in the CORONADO study, and the relationship between BMI and the primary outcome was not evident in people >75 years of age ( Smati et al., 2021 ).…”

“…In contrast, insulin use is frequently required and often the only therapy available for use in people with poorly controlled T2D, or in older individuals with a longer duration of T2D and established cardiovascular and kidney disease, risk factors known to be associated with suboptimal outcomes in people with severe COVID-19 ( Drucker, 2020 ). Similarly, use of GLP-1 receptor agonists and insulin is more common in people with both T2D and obesity, a cohort at risk for cardiovascular complications and greater severity of COVID outcomes ( Smati et al., 2021 ). Hence, it is not surprising that multiple retrospective studies of COVID-19 outcomes in T2D associate insulin use prior to hospitalization with greater COVID-19-related mortality ( Agarwal et al., 2020 ; Chen et al., 2020b ; Riahi et al., 2020 ).…”

Diabète et COVID-19 : les leçons de CORONADO

“…Nous avons donc étudié spécifiquement dans CORONADO quel était l’impact de l’obésité sur le pronostic de la COVID-19 dans un contexte de diabète. Nous avons restreint cette analyse aux seuls patients DT2 avec un suivi à j7 [14] . En analyse multivariée, il apparait ainsi que la survenue du CPJ à j7 est significativement associée au surpoids (IMC entre 25,0 et 30,0 kg/m 2 ) et à l’obésité de grade 1 (IMC entre 30,0 et 35,0 kg/m 2 ) et de grade II-III (IMC > 35,0 kg/m 2 ) avec des RC à 1,65 [IC95 % : 1,05–2,59], 1,93 [IC95 % : 1,19–3,14] et 1,98 [IC95 % : 1,11–3,52], respectivement.…”

“…En analyse multivariée, il apparait ainsi que la survenue du CPJ à j7 est significativement associée au surpoids (IMC entre 25,0 et 30,0 kg/m 2 ) et à l’obésité de grade 1 (IMC entre 30,0 et 35,0 kg/m 2 ) et de grade II-III (IMC > 35,0 kg/m 2 ) avec des RC à 1,65 [IC95 % : 1,05–2,59], 1,93 [IC95 % : 1,19–3,14] et 1,98 [IC95 % : 1,11–3,52], respectivement. L’obésité est associée au risque d’intubation, mais pas au risque de décès à j7 [14] . L’analyse des données à j28 sur l’ensemble de la cohorte a confirmé l’absence d’association entre IMC et risque de décès à j28 [5] .…”

Trajectories of Key Physiological Parameters in COVID-19 Patients Using Continuous Remote Monitoring and Health AI

“…Moreover, by using this technology with COVID-19 patients we now have an opportunity to de ne a novel COVID-19 score for the accurate early detection of deterioration. Due to sex-, age-, and BMI-related differences in disease progression [33][34][35][36][37][38][39][40] , it might be prudent to de ne a separate score for individuals based on their basic characteristics. This tailored precision medicine approach should be further studied.…”