Risk Factors for Poor Outcomes of Diabetes Patients With COVID-19: A Single-Center, Retrospective Study in Early Outbreak in China

Abstract

Background: Diabetes has been found to increase severity and mortality under the current pandemic of coronavirus disease of 2019 (COVID-19). Up to date, the clinical characteristics of diabetes patients with COVID-19 and the risk factors for poor clinical outcomes are not clearly understood. Methods: The study was retrospectively carried out on enrolled diabetes patients with laboratory confirmed COVID-19 infection from a designated medical center for COVID-19 from January 25th, 2020 to February 14th, 2020 in Wuhan, China. The medical record was collected and reviewed. Univariate and multivariate analyses were performed to assess the risk factors associated with the severe events which were defined as a composite endpoint of admission to intensive care unit, the use of mechanical ventilation, or death. Results: A total of 52 diabetes patients with COVID-19 were finally included in the study. 21 (40.4%) patients had developed severe events in 27.50 (IQR 12.25–35.75) days follow-up, 15 (28.8%) patients experienced life-threatening complications and 8 patients died with a recorded mortality rate of 15.4%. Only 13 patients (41.9%) were in optimal glycemic control with HbA1c value of <7.0%. In addition to general clinical characteristics of COVID-19, the severe events diabetes patients showed higher counts of white blood cells and neutrophil, lower lymphocytes (40, 76.9%), high levels of hs-CRP, erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) as compared to the non-severe diabetes patients. Mild higher level of cardiac troponin I (cTNI) (32.0 pg/ml; IQR 16.80–55.00) and D-dimer (1.70 μg/L, IQR 0.70–2.40) were found in diabetes patients with severe events as compared to the non-severe patients (cTNI:20.00 pg/ml, IQR5.38–30.00, p = 0.019; D-dimer: 0.70 μg/L, IQR 0.30–2.40, p = 0.037). After adjusting age and sex, increased level of cTNI was found to significantly associate with the incidence of severe events (HR: 1.007; 95% CI: 1.000–1.013; p = 0.048), Furthermore, using of α-glucosidase inhibitors was found to be the potential protectant for severe events (HR: 0.227; 95% CI: 0.057–0.904; p = 0.035). Conclusion: Diabetes patients with COVID-19 showed poor clinical outcomes. Vigorous monitoring of cTNI should be recommended for the diabetes patients with COVID-19. Usage of α-glucosidase inhibitors could be a potential protectant for the diabetes patients with COVID-19.

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

“…Nevertheless, for diabetes, there is a slightly higher association in the Centre, South, and Yucatan peninsula. The associations have also been reported in other studies in other geographical regions [31][32][33], and although it is still under study, they may be associated with inflammatory stages [34]. Finally, the proportion of individuals between 10 and 39 years old has a relatively similar effect throughout Mexico.…”

Dipeptidyl peptidase 4 (DPP4) inhibitor and outcome from coronavirus disease 2019 (COVID-19) in diabetic patients: a systematic review, meta-analysis, and meta-regression

“…A total of 4592 records were excluded after screening the titles/abstracts because they did not match our inclusion and exclusion criteria. After evaluating 22 full-texts for eligibility, 7 full-text articles were excluded because they do not have the outcome of interest (severe COVID-19 or mortality), 3 full-text articles were excluded because they do not have the control/comparison group, 2 articles were excluded because the full text not in English, and finally, 10 studies [16][17][18][19][20][21][22][23][24][25] with a total of 7012 COVID-19 patients with diabetes were included in the meta-analysis (Fig. 1).…”

Metformin in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…To examine the association between metformin use and other outcomes, we conducted a further meta-analyses of two (33,52), five (35,38,39,41,48,49), and four (29)(30)(31)47) studies estimating the association between metformin use and risk of intubation, deterioration, and hospitalization. The pooled ORs of metformin use with intubation, deterioration, and hospitalization were 0.94 (95% CI, 0.77-1.16; I 2 = 0.0%), 2.04 (95% CI, 0.65-6.34; I 2 = 79.4%), and 0.73 (95% CI, 0.53-1.00; I 2 = 16.8%), respectively (Supplementary Figures 2-4).…”