Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United States
Wataru Ando, Takeshi Horii, Takayuki Uematsu, Hideaki Hanaki, Koichiro Atsuda, Katsuya Otori
Scientific Reports, doi:10.1038/s41598-021-96720-x
The impact of overlapping risk factors on coronavirus disease (COVID-19) severity is unclear. To evaluate the impact of type 2 diabetes (T2D) and obesity on COVID-19 severity, we conducted a cohort study with 28,095 anonymized COVID-19 patients using data from the COVID-19 Research Database from January 1, 2020 to November 30, 2020. The mean age was 50.8 ± 17.5 years, and 11,802 (42%) patients were male. Data on age, race, sex, T2D complications, antidiabetic medication prescription, and body mass index ≥ 30 kg/m 2 (obesity) were analysed using Cox proportional hazard models, with hospitalization risk and critical care within 30 days of COVID-19 diagnosis as the main outcomes. The risk scores were 0-4 for age ≥ 65 years, male sex, T2D, and obesity. Among the participants, 11,294 (61.9%) had obesity, and 4445 (15.8%) had T2D. T2D, obesity, and male sex were significantly associated with COVID-19 hospitalization risk. Regarding hospitalization risk scores, compared with those for hospitalization risk score 0 and critical care risk score 0, hazard ratios [95% confidence intervals] were 19.
www.nature.com/scientificreports/ patients. Therefore, further studies are required to evaluate the effects of blood glucose control and obesity on COVID-19. The BMI data comprise values measured up to 6 months prior to this study and may not accurately reflect the values immediately before the diagnosis of COVID-19. Because of the small number of cases of fatty liver and the exclusive availability of Non-alcoholic fatty liver disease (NAFLD) in CPT4 codes, the risk of COVID-19 severity in patients with fatty liver should be studied in detail in a larger population. Confounding factors for hospitalization and critical care risks should consider non-diabetic complications such as cardiovascular events. We hypothesized that there would be a period in the early phase of the epidemic (in the first half of 2020) when the high number of patients would overwhelm the health care system, and treatment of the most critically ill patients would be prioritized. Therefore, we attempted to examine the risk in early 2020. However, because of limited data in the early phase of the epidemic and concerns about accuracy, this database is not considered to have adequately accounted for the relative risks of outcomes related to diabetes, age, and BMI. Therefore, we hope that this issue will be clarified in the future as the risk of severe disease was unevenly distributed during the acute phase of the pandemic. In examining the risk score, we considered the weight of the patients; however, it was..
References
Best, Baseline demographics and clinical characteristics among 3471 US patients hospitalized with COVID-19 and pulmonary involvement: A retrospective study, Adv. Ther,
doi:10.1007/s12325-020-01510-yBossi, Forloni, Colombelli, Lack of efficacy of SGLT2-i in severe pneumonia related to novel coronavirus (nCoV) infection: No little help from our friends, Diabetes Ther,
doi:10.1007/s13300-020-00844-8Cases, COVID-19 Hospitalization and Death by Age
Cheng, Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010, Diabetes Care,
doi:10.2337/dc12-2074Fox, Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association, Diabetes Care,
doi:10.2337/dci15-0012Fried, Patient characteristics and outcomes of 11,721 patients with COVID19 hospitalized across the United States, Clin. Infect. Dis,
doi:10.1093/cid/ciaa1268Gold, Race, ethnicity, and age trends in persons who died from COVID-19: United States, MMWR Morb. Mortal. Wkly. Rep,
doi:10.15585/mmwr.mm6942e1Goodman, Impact of sex and metabolic comorbidities on COVID-19 mortality risk across age groups: 66,646 inpatients across 613, Clin. Infect. Dis,
doi:10.1093/cid/ciaa1787Grasselli, Pathophysiology of COVID-19-associated acute respiratory distress syndrome: A multicentre prospective observational study, Lancet Respir. Med,
doi:10.1016/S2213-2600(20)30370-2Hamer, Gale, Kivimaki, Batty, Overweight, obesity, and risk of hospitalization for COVID-19: A communitybased cohort study of adults in the United Kingdom, Proc. Natl. Acad. Sci. U. S. A,
doi:10.1073/pnas.2011086117Holman, Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: A populationbased cohort study, Lancet Diabetes Endocrinol,
doi:10.1016/S2213-8587(20)30271-0Izurieta, Natural history of COVID-19: Risk factors for hospitalizations and deaths among > 26 million U.S. Medicare beneficiaries, J. Infect. Dis,
doi:10.1093/infdis/jiaa767Kosiborod, Effects of dapagliflozin on prevention of major clinical events and recovery in patients with respiratory failure because of COVID-19: Design and rationale for the DARE-19 study, Diabetes Obes. Metab,
doi:10.1111/dom.14296Kow, Hasan, Mortality risk with preadmission metformin use in patients with COVID-19 and diabetes: A meta-analysis, J. Med. Virol,
doi:10.1002/jmv.26498Lalau, Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19, Diabetes Metab,
doi:10.1016/j.diabet.2020.101216Liang, Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19, JAMA Intern. Med,
doi:10.1001/jamainternmed.2020.2033Lundon, Social determinants predict outcomes in data from a multi-ethnic cohort of 20,899 patients investigated for COVID-19, Front. Public Health,
doi:10.3389/fpubh.2020.571364Nishiga, Wang, Han, Lewis, Wu, COVID-19 and cardiovascular disease: From basic mechanisms to clinical perspectives, Nat. Rev. Cardiol,
doi:10.1038/s41569-020-0413-9Patoulias, Papadopoulos, Katsimardou, Toumpourleka, Doumas, Sodium-glucose cotransporter 2 inhibitors and major COVID-19 outcomes: Promising mechanisms, conflicting data, and intriguing clinical decisions, Diabetes Ther,
doi:10.1007/s13300-020-00942-7Perez-Belmonte, Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: A nationwide cohort study, BMC Med,
doi:10.1186/s12916-020-01832-2Perkin, Deaths in people from Black, Asian and minority ethnic communities from both COVID-19 and non-COVID causes in the first weeks of the pandemic in London: A hospital case note review, BMJ Open,
doi:10.1136/bmjopen-2020-040638Popkin, Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships, Obes. Rev,
doi:10.1111/obr.13128Raisi-Estabragh, Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: Study of 1326 cases from the UK Biobank, J. Public Health (Oxf.),
doi:10.1093/pubmed/fdaa095Ssentongo, Ssentongo, Heilbrunn, Ba, Chinchilli, Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis, PLoS ONE,
doi:10.1371/journal.pone.0238215Wang, Type 2 diabetes mellitus is associated with increased risks of sarcopenia and pre-sarcopenia in Chinese elderly, Sci. Rep,
doi:10.1038/srep38937Wikner, Gigante, Hellenius, De Faire, Leander, The risk of type 2 diabetes in men is synergistically affected by parental history of diabetes and overweight, PLoS ONE,
doi:10.1371/journal.pone.0061763
