Diabetes Metab J.  2020 Aug;44(4):602-613. 10.4093/dmj.2020.0146.

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

• Kim MK
• Jeon JH
• Kim SW
• Moon JS
• Cho NH
• Han E
• You JH
• Lee JY
• Hyun M
• Park JS
• Kwon YS
• Choi YK
• Kwon KT
• Lee SY
• Jeon EJ
• Kim JW
• Hong HL
• Kwon HH
• Jung CY
• Lee YY
• Ha E
• Chung SM
• Hur J
• Ahn JH
• Kim Ny
• Kim SW
• Chang HH
• Lee YH
• Lee J
• Park KG
• Kim HA
• Lee JH

• KMID: 2513019
• DOI: http://doi.org/10.4093/dmj.2020.0146

Abstract

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.

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.

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.

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.

Keyword

COVID-19; Diabetes mellitus; Mortality; Prognosis

Figure

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  Fig. 1 Flow chart of the study. COVID-19, coronavirus disease 2019; KNUH, Kyungpook National University Hospital; DSMC, Dongsan Medical Center; KNUCH, Kyungpook National University Chilgok Hospital; DCMC, Daegu Catholic Medical Center; PCR, polymerase chain reaction; DM, diabetes mellitus; PS, propensity score.

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  Fig. 2 Mortality due to coronavirus disease 2019 in all patients (A) and propensity score-matched patients (B). The data were analyzed using the Kaplan-Meier method, and hazard ratios were calculated using a Cox proportional hazards model. Data are expressed as hazard ratio (HR) (95% confidence intervals [CI]). DM, diabetes mellitus

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  Fig. 3 Mortality of coronavirus disease 2019 patients in subgroups defined according to age and sex. Patients aged <70 years (A) and >70 years (B); and male (C) and female (D) patients. Data were analyzed using a Cox proportional hazards model. Data are expressed as hazard ratio (HR) (95% confidence intervals [CI]). The model was adjusted for age, sex, and the presence of underlying diseases.

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