Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication
Yuchen Chen, Dong Yang, Biao Cheng, Jian Chen, Anlin Peng, Chen Yang, Chong Liu, Mingrui Xiong, Aiping Deng, Yu Zhang, Ling Zheng, Kun Huang
Diabetes Care, doi:10.2337/dc20-0660
Diabetes is one of the most distinct comorbidities of COVID-19. Here, we describe the clinical characteristics of and outcomes in patients with diabetes in whom COVID-19 was confirmed or clinically diagnosed (with typical features on lung imaging and symptoms) and their association with glucose-lowering or blood pressure-lowering medications.
RESEARCH DESIGN AND METHODS In this retrospective study involving 904 patients with COVID-19 (136 with diabetes, mostly type 2 diabetes), clinical and laboratory characteristics were collected and compared between the group with diabetes and the group without diabetes, and between groups taking different medications. Logistic regression was used to explore risk factors associated with mortality or poor prognosis.
RESULTS The proportion of comorbid diabetes is similar between cases of confirmed and of clinically diagnosed COVID-19. Risk factors for higher mortality of patients with diabetes and COVID-19 were older age (adjusted odds ratio [aOR] 1.09 [95% CI 1.04, 1.15] per year increase; P 5 0.001) and elevated C-reactive protein (aOR 1.12 [95% CI 1.00, 1.24]; P 5 0.043). Insulin usage (aOR 3.58 [95% CI 1.37, 9.35]; P 5 0.009) was associated with poor prognosis. Clinical outcomes of those who use an ACE inhibitor (ACEI) or angiotensin II type-I receptor blocker (ARB) were comparable with those of patients who do not use ACEI/ARB among COVID-19 patients with diabetes and hypertension.
CONCLUSIONS C-reactive protein may help to identify patients with diabetes who are at greater risk of dying during hospitalization. Older patients with diabetes were prone to death related to COVID-19. Attention needs to be paid to patients with diabetes and COVID-19 who use insulin. ACEI/ARB use showed no significant impact on patients with diabetes and hypertension who have COVID-19.
References
Adhikari, Meng, Wu, Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review, Infect Dis Poverty
Chan-Yeung, Xu, SARS: epidemiology, Respirology
Chen, Liu, Cheng, Zheng, Huang, Effects of apelin peptides on diabetic complications, Curr Protein Pept Sci
Chen, Zhang, Yang, Fangcang shelter hospitals: a novel concept for responding to public health emergencies [published correction appears in Lancet 2020, Lancet
Fang, Karakiulakis, Roth, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?, Lancet Respir Med
Garbati, Fagbo, Fang, A comparative study of clinical presentation and risk factors for adverse outcome in patients hospitalised with acute respiratory disease due to MERS coronavirus or other causes, PLoS One
Giovannelli, Trouiller, Hulo, Low-grade systemic inflammation: a partial mediator of the relationship between diabetes and lung function, Ann Epidemiol
Guan, Ni, Hu, China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med
Gupta, Ghosh, Singh, Misra, Clinical considerations for patients with diabetes in times of COVID-19 epidemic, Diabetes Metab Syndr
Harding, Pavkov, Magliano, Shaw, Gregg, Global trends in diabetes complications: a review of current evidence, Diabetologia
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Kulcsar, Coleman, Beck, Frieman, Gupta et al., Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection, Front Immunol
Li, Guan, Wu, Early transmission dynamics in Wuhan, China, of novel coronavirusinfected pneumonia, N Engl J Med
Li, Yao, Li, Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19, J Med Virol,
doi:10.1002/jmv.25786Li, Yi, Luo, Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis, J Med Virol,
doi:10.1002/jmv.25727Li, Zhang, Zhuo, The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases, Pharmacol Res
Pan, Liu, Wang, Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China, JAMA,
doi:10.1001/jama.2020.6130Pearson-Stuttard, Blundell, Harris, Cook, Critchley, Diabetes and infection: assessing the association with glycaemic control in population-based studies, Lancet Diabetes Endocrinol
Teeter, Riese, Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study: response to Yeh et al, Diabetes Care
Wan, Shang, Graham, Baric, Li, Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus, J Virol
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, JAMA
Yang, Feng, Yuan, Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS, Diabet Med
Yeh, Punjabi, Wang, Crosssectional and prospective study of lung function in adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study, Diabetes Care
Zhao, Yao, Wang, A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias, Clin Infect Dis,
doi:10.1093/cid/ciaa247Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
