Severe COVID-19 and Diabetes - A Retrospective Cohort Study from Three London Teaching Hospitals

Abstract

Patients with diabetes mellitus admitted to hospital with COVID-19 caused by infection with the novel coronavirus (SARS-CoV-2) have poorer outcomes. However, the drivers for this are not fully elucidated. We performed a retrospective cohort study, including detailed pre-hospital and presenting clinical and biochemical factors of 889 patients diagnosed with COVID-19 in three constituent hospitals of a large London NHS Trust. 62% of patients with severe COVID-19 were of non-White ethnic backgrounds and the prevalence of diabetes was 38%. 323 (36%) patients met the primary outcome of death or admission to the intensive care unit (ICU) within 30 days of diagnosis. Male gender, advancing age and the Clinical Frailty Scale, an established measure of multimorbidity, independently predicted poor outcomes on multivariate analysis. Diabetes did not confer an independent risk for adverse outcomes in COVID-19, although patients with diabetes and ischaemic heart disease were at particular risk. Additional risk factors which significantly and independently associated with poorer outcomes in patients with diabetes were age, male gender and lower platelet count. Antiplatelet medication was associated with a lower risk of death/ICU admission and should be evaluated in randomised clinical trials amongst high risk patient groups.

Non-insulin anti-diabetic agents in patients with type 2 diabetes and COVID-19: A Critical Appraisal of Literature

“…Similarly, Izzi-Engbeaya et al. [ 20 ] reported no difference in primary outcome of ICU admissions or deaths within 30 days (OR 0.66; 95% CI, 0.30–1.52; p = 0.59) in SU-users (74/337), in a univariate analysis. Further the prospective study of patients with diabetes in COVID-19, CORONADO found neither detrimental nor beneficial effects on primary or secondary outcome in the combined groups of SU and glinides-users (n = 367) both in its interim report at day 7 and in final report of day 28 [ 21 , 29 ].…”

“…Similarly, in a univariate analysis, Izzi-Engbeaya et al. [ 20 ] reported no difference in primary outcome of ICU admissions or deaths within 30 days (OR 0.66; 95% CI, 0.30–1.52; p = 0.40) amongst SGLT-2i users (24/337) compared to the non-users. On the contrary, in a multivariate analysis of a retrospective study by Dalan et al.…”

“…Meanwhile, several small to large retrospective studies and one large prospective study have reported the outcomes with metformin in patients of T2DM with COVID-19 [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ]. While some studies [ [17] , [18] , [19] , [20] , [21] ] found neither any harm nor any benefit in metformin users when compared to non-users both in severity and mortality outcomes, majority [ [23] , [24] , [25] , [26] , [27] , [28] , [29] ] reported a significant reduction in mortality. Interestingly, one study reported even an increase in severity in metformin users [ 22 ].…”

“…A reduced trend of in-hospital deaths was also observed in metformin users, compared to the non-users (9.3 vs. 19.5%, respectively; p = 0.19) in this retrospective study. Subsequently, several small to moderately large retrospective studies [ [18] , [19] , [20] ] reported no difference in either severity of COVID-19 or death in metformin users as compared to the non-users. First prospective study of Coronavirus Disease and Diabetes Outcome (CORONADO) (n = 1317) was conducted in patients with diabetes and COVID-19.…”

“…In a retrospective study, Izzi-Engbeaya et al. [ 20 ] reported no difference in primary outcome of ICU admissions or deaths within 30 days (OR 0.52; 95% CI, 0.09–2.60; p = 0.66) in GLP-1RA users (5/337), in a univariate analysis. Similarly, in CORONADO interim report where 123/1317 patients were receiving GLP-1RAs, both tracheal intubation and or death (unadjusted OR 1.36; 95% CI, 0.92–2.01) and death at day 7 (unadjusted OR 0.64; 95% CI, 0.32–1.29) were similar in GLP-1RA users, compared to the non-users in an unadjusted analysis [ 21 ].…”