Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

Abstract

AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

Association of statin and/or renin-angiotensin-aldosterone system modulating therapy with mortality in adults with diabetes admitted to hospital with COVID-19: A retrospective multicentre European study

“…COVID-19 infection is associated with poorer outcome for those with long-term conditions, such as diabetes, and several potential mechanisms have been proposed [ 6 , 9 ]. This paper specifically examined medications used by many people with diabetes (type 1 and 2) for the prevention of diabetic complications and, therefore, the potential detrimental or beneficial effect of these medications on outcomes for this specific population.…”

“…Adults with hyperglycaemia at admission, but not pre-existing or subsequent diagnosis of diabetes (based on WHO criteria) were excluded from analysis [ 8 ]. Further descriptions of each nation's dataset have been published previously [ [9] , [10] , [11] , [12] ].…”

“…The six hospitals in the HM Hospitales group collected anonymized observational data for people infected with COVID-19 during the first wave. This dataset is made available to researchers via “Covid Data Save Lives” [ 9 ]. The electronic hospital health records were collected for admitted persons including pre-existing disease status, medication use, demographic and outcome.…”

Recent Progress in the Diagnosis and Management of Type 2 Diabetes Mellitus in the Era of COVID-19 and Single Cell Multi-Omics Technologies

“…Metabolic diseases such as DM are associated with an increased risk of a severe COVID-19 illness and death because of their associated hypercoagulation state and uncontrolled inflammation [ 148 ], although it seems that T1DM patients have higher risk than T2DM patients. Epidemiological studies have shown that hospitalization with diabetes and SARS-CoV-2 infection represents as a comorbidity with poor outcome during hospital stay [ 149 ]. A recent study reported that 15% of T2DM patients died from COVID-19, with the poor prognoses for those of elder age and elevated glucose and serum amyloid A levels [ 150 ].…”

SARS-CoV2 Infection and Comorbidities, Role in Oncogenesis

“…High glucose level is the basal laboratory test widely used for indicating the risk of poor outcomes (Ortega et al 2021). Impaired Fasting Glucose and diabetes at admission were associated with higher risks of adverse effects among patients with COVID-19 (Zhang et al, 2020).…”