The relationship between diabetes and clinical outcomes in COVID-19: a single-center retrospective analysis

Fox, Tamaryn; Ruddiman, Kathleen; Lo, Kevin Bryan; Peterson, Eric; DeJoy, Robert; Salacup, Grace; Pelayo, Jerald; Bhargav, Ruchika; Gul, Fahad; Albano, Jeri; Azmaiparashvili, Zurab; Anastasopoulou, Catherine; Patarroyo‐Aponte, Gabriel

doi:10.1007/s00592-020-01592-8

Cited by 40 publications

(39 citation statements)

References 18 publications

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“…Patients with type 2 diabetes were twice as likely to die compared with patients without diabetes, which is in accordance with findings in previous studies (5,6,25,28,31). However, the significant association between type 2 diabetes and mortality was lost after adjustment of models for age and sex, whereas cardiovascular diseases, CKD, and cancer were shown to be independent risk factors of mortality.…”

Section: Discussionsupporting

confidence: 91%

“…Prevalence of type 2 diabetes in this cohort was 23.3%, which is higher than that previously reported in publications from China (5,6,17) and similar to that in Europe (25,28) but lower than data from the U.S. (29)(30)(31). Compared with subjects without diabetes of this study, the subset of patients with type 2 diabetes was older and burdened by a higher prevalence of comorbidities (i.e., hypertension, CAD, CKD, and stroke) and related polypharmacy, with many patients taking multiple medications (including antihypertensive, lipid-lowering, and antiplatelet/anticoagulants drugs).…”

Section: Discussioncontrasting

confidence: 60%

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Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

et al. 2020

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Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients. RESEARCH DESIGN AND METHODS This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality. RESULTS Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95; P 5 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35; P 5 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38; P 5 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55; P 5 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42; P 5 0.04) but not with type 2 diabetes (P 5 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L; P 5 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase; P 5 0.007) as well as treatments with insulin (aHR 3.05, 95% CI 1.57-5.95; P 5 0.001) and b-blockers (aHR 3.20, 95% CI 1.50-6.60; P 5 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92; P 5 0.042). CONCLUSIONS Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 60%

Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

et al. 2020

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“…The patients in our study were older and had more severe conditions than those in the nationwide analysis [20,21]. Therefore, a higher prevalence of diabetes was expected in this study, similar to that reported by medical centres in Western countries [6,11,24,25]. This might also suggest an association between pre-existing diabetes and an increased severity of COVID-19.…”

Section: Discussionsupporting

confidence: 84%

Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19

Liu

Wang

et al. 2020

Preprint

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Aims: Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19.Methods: This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was 6.5% (≥ 48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results: Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs 5.9%, p <0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥ 1.0 mg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19.Conclusions: The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

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Section: Discussionsupporting

confidence: 84%

“…The reported mortality rate for hospitalised patients with COVID-19 ranges from 1.4-22.5%, which may be due to different characteristics of patient populations, such as age, comorbidities, and the availability of medical resources [3][4][5][6]. Studies have shown that elderly patients with underlying comorbidities are at a greater risk of poor outcomes [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Diabetes, Even Newly Defined by HbA1c Testing, Is Associated With an Increased Risk of in-hospital Death in Adults With COVID-19

Liu

Wang

et al. 2020

Preprint

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Background: Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19.Methods: This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was 6.5% (≥ 48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results: Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs 5.9%, p <0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p <0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥ 1.0 mg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19.Conclusions: The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

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The relationship between diabetes and clinical outcomes in COVID-19: a single-center retrospective analysis

Abstract: Aims Coronavirus disease 19 (COVID-19) has become a pandemic. Diabetic patients tend to have poorer outcomes and more severe disease (

Cited by 40 publications

References 18 publications

Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19

Diabetes, Even Newly Defined by HbA1c Testing, Is Associated With an Increased Risk of in-hospital Death in Adults With COVID-19

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