Diabetes Metab J.  2020 Jun;44(3):405-413. 10.4093/dmj.2020.0105.

The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study

• Chung SM
• Lee YY
• Ha E
• Yoon JS
• Won KC
• Lee HW
• Hur J
• Hong KS
• Jang JG
• Jin HJ
• Choi EY
• Shin KC
• Chung JH
• Lee KH
• Ahn JH
• Moon JS

• KMID: 2512998
• DOI: http://doi.org/10.4093/dmj.2020.0105

Abstract

To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.

This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.

After exclusion, 110 participants were finally included. DM patients (n=29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771; P<0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175; P=0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048; P=0.045).

The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.

Keyword

Aged; COVID-19; Diabetes mellitus; Prognosis; Risk factors; Severe acute respiratory syndrome coronavirus 2

Figure

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  Fig. 1 Patient selection. COVID-19, coronavirus disease 2019; DM, diabetes mellitus.

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  Fig. 2 Diabetes mellitus (DM) and age as a risk factor for severe and critical outcomes in patients with coronavirus disease 2019. Severe and critical outcomes: composite outcome of acute respiratory distress syndrome, septic shock, intensive care unit care, and mortality within 28 days. Multivariate logistic regression analysis was adjusted by (A) age (<70:≥70 years old), sex, smoking status, and the presence of comorbidities (diabetes mellitus, hypertension, chronic lung disease, and malignancy) in the total number of patients and (B) age (continuous), sex, smoking status, and glycosylated hemoglobin (HbA1c), and serum glucose levels among diabetic patients. The odds ratios (ORs) are presented in log10. CI, confidence interval.

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  Fig. 3 Effects of (A) metformin and (B) RAS inhibitors on severe and critical outcomes, acute cardiac injury, and acute kidney injury in diabetic patients with coronavirus disease 2019. Severe and critical outcomes: composite outcome of acute respiratory distress syndrome, septic shock, intensive care unit care, and mortality within 28 days. Multivariate logistic regression analysis was adjusted by age, sex, smoking status, and glycosylated hemoglobin level. The odds ratios (ORs) are presented in log10. CI, confidence interval.

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