For some time researchers have known that COVID-19 patients with underlying conditions fare much worse than the general affected population. Early reports identified diabetes as a particularly destructive condition in this respect, and now a new paper published in the journal Diabetologia demonstrates the severity of the terms.
The report, which is the first of its kind, revealed that one in 10 hospitalized COVID-19 patients with diabetes dies within seven days of hospital admission, and one in five is intubated and mechanically ventilated in this same window.
“We conducted a nationwide multicentre observational study in people with diabetes hospitalized for COVID-19 in 53 French centers in the period 10–31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission,” the authors write in the new paper. “In people with diabetes hospitalized for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days.”
Characteristics and prognosis of inpatients with COVID-19 and diabetes
“Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown,” the authors continued.
The researchers began by analyzing 1,317 confirmed COVID-19 cases—the average age of which was 70.
Eighty-nine percent of the study pool had been previously diagnosed with type 2 diabetes and 3% had type 1 diabetes by the time the research began. Two thirds (65%) of COVID-19 patients diagnosed with diabetes were men.
Forty-seven percent of the subjects evidenced neuropathies, and eye and kidney complications while macrovascular complications (arteries of the heart, brain, legs) were present in 41% of the patients reviewed. Each of these compounded the mortality risk associated with diabetes. In fact, the appearance of microvascular or macrovascular complications each more than doubled the risk of death at day seven.
Other aggravators included were advanced age, the presence of obstructive sleep apnoea (this nearly tripled the risk of death at 7 days), and the presence of dyspnoea symptoms (shortness of breath).
Eighteen percent of all of the patients included in the study were discharged from hospital care before the conclusion of the research.
By day seven, 20.3% of the study pool had been intubated and placed on a ventilator in intensive care, and10.3% had succumbed to the illness. No patients with type 1 diabetes died during the study period.
The next phase of research will begin this summer and will include roughly 3000 patients with diabetes hospitalized with COVID-19 28 days after admission to the hospital.
“The risk factors for severe forms of COVID-19 are identical to those found in the general population: age and BMI,” the authors conclude. “Elderly populations with long-term diabetes with advanced diabetic complications and/or treated obstructive sleep apnoea were particularly at risk of early death and might require specific management to avoid infection with the novel coronavirus. BMI also appears as an independent prognostic factor for COVID-19 severity in the population living with diabetes requiring hospital admission. The link between obesity and COVID-19 requires further study.”
The authors stress that treatment designed to modify blood sugar, is not a risk factor for severe forms of COVID-19.
CW Headley is a reporter for the Ladders and can be reached at email@example.com