The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID‐19

Abstract

Background: Although type 2 diabetes mellitus (T2DM) patients with coronavirus disease 2019 (COVID-19) develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with antihyperglycemic drugs and glucocorticoids is unclear. Methods: From 1584 COVID-19 patients, 364 severe/critical COVID-19 patients with clinical outcome were enrolled for the final analysis, and patients without preexisting T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes. Results: Of 364 enrolled severe COVID-19 inpatients, 114 (31.3%) had a history of T2DM. Twenty-seven (23.7%) T2DM patients died, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury compared with non-DM patients. In severe COVID-19 patients with T2DM, we demonstrated a higher risk of all-cause fatality with glucocorticoid treatment (adjusted hazard ratio [HR], 3.61; 95% CI, 1.14-11.46; P = .029) and severe hyperglycemia (fasting plasma glucose ≥11.1 mmol/L; adjusted HR, 11.86; 95% CI, 1.21-116.44; P = .034). Conclusions: T2DM status aggravated the clinical condition of COVID-19 patients and increased their critical illness risk. Poor fasting blood glucose (≥ 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID-19. K E Y W O R D S antihyperglycemic drugs, clinical status, coronavirus disease 2019 (COVID-19), glucocorticoid, type 2 diabetes Highlights • Type 2 diabetes mellitus (T2DM) patients with severe acute respiratory syndrome coronavirus 2 infection had more severe inflammation, coagulation Solomon Tesfaye, Qingtao Meng, and Ling Gao contributed equally to this paper.

The Association Between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted January 27, 2021. ; https://doi.org/10.1101/2021.01.26.21250506 doi: medRxiv preprint 16 studies were included in qualitative synthesis. Among these, 12 studies related to metformin (15,16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), 6 studies related to DPP-4i (27,28,33,(35)(36)(37)(38), 3 studies related to sulfonylurea or glinides (27,28,33,35), 2 studies related to SGLT-2i (33,35) and 1 study related to GLP-1RA (27,28). Some of these studies included multiple outcomes to different medications.…”

“…One study investigated the combined use of sulfonylurea and glinides, and found no statistically significant effect on death or tracheal intubation (27). In addition, no statistically significant result of sulfonylurea's effect on death or severe disease was found in another study (33), and the last was a case-series study without reporting group outcomes (35).…”

Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19

“…Recent work has highlighted the intersection between dysglycemia, diabetes mellitus (DM), and outcomes in COVID-19. Multiple studies have revealed a connection between DM and worse outcomes from COVID-19, including increased mortality and organ failure ( 1 , 2 , 3 , 4 ). Zhu and colleagues provided data suggesting that maintaining euglycemia (70-180 mg/dL) in patients with type 2 DM reduced the occurrence of death, acute respiratory distress syndrome, septic shock, acute kidney injury, and renal-replacement therapy in a cohort of hospitalized patients in China ( 1 ).…”

MCCS: a novel recognition pattern-based method for fast track discovery of anti-SARS-CoV-2 drugs

“…In addition, recent studies [ 50 , 51 ] showed that type II diabetes patients with COVID-19 develop a more severe condition compared to those without diabetes. From Table 2 , we also predicted three antidiabetic drugs (acarbose, glyburide and tolazamide) with the potential to treat COVID-19 coexisting with type II diabetes [ 52 ].…”