The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea

Abstract

Background Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes. Methods We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group. Results Compared with the non-DM group ( n =847), patients with DM ( n =235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease. Conclusion DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq

“…DPP-4 inhibitors may exert immune regulatory functions, that are potentially beneficial in autoimmune and inflammatory diseases, such as rheumatoid arthritis. [ 5] An upregulation of DPP-4 in patients with DM remains a plausible explanation for the greater severity of COVID-19 in patients with DM [ 20 ]. A recent meta-analysis (n = 1607 patients with DM; 16 trials) found a significant reduction in inflammatory markers following DPP-4 inhibitors use compared with placebo [ 18 , 21 ].…”

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

“…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 ].…”

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

“…Diabetes, cardiovascular diseases (CVD) and other NCDs were recognized as major risk factors to hospitalization, intensive care needs and death due to the novel 2019 coronavirus [4,5,6,7,8,9,10,11,12,13]. Data from different parts of the world, included both in the news and scientific reports, pointed out that the overall SARS-CoV-2 case-fatality rate of 2.3%, was actually more than three times higher (7.3%) when diabetes was present [4].…”