COVID-19 and diabetes: 1 in 10 who are hospitalized die within a week

  • Cariou B & al.
  • Diabetologia
  • 29 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Among patients with diabetes hospitalized for COVID-19, 1 in 10 die within a week.
  • BMI was independently associated with risk for tracheal intubation and/or death within 7 days, but HbA1c was not in this large French study.

Why this matters

  • Specific characteristics predicting worse inpatient COVID-19 outcomes among patients with diabetes have not been identified.

Study design

  • Observational study of 1317 patients with COVID-19 and diabetes at 53 French hospitals, March 10-31, 2020.
  • Primary outcome: combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission.
  • Funding: Several French diabetes societies; Novo Nordisk; MSD; Abbott; AstraZeneca; others.

Key results

  • Among the 1317 patients, at day 7:
    • 29% had the primary composite outcome.
    • 20.3% were intubated.
    • 10.6% died.
    • 18% were discharged.
  • No associations were identified with HbA1c, renin-angiotensin-aldosterone system blockers, or dipeptidyl peptidase-4 inhibitors.
  • In multivariable analysis, BMI was independently associated with the primary composite outcome:
    • aOR: 1.28 for each standard deviation (95% CI, 1.10-1.47).
  • Factors independently associated with death (ORs):
    • Age: 2.39 (P<.0001>
    • Macrovascular complications: 2.26 (P=.0069).
    • Treated obstructive sleep apnea: 2.65 (P=.0044).
    • Increased aspartate aminotransferase: 1.93 (P=.0001). 
    • C-reactive protein: 1.7 (P=.0202).
    • Decreased estimated glomerular filtration rate: 0.51 (P<.0001>
    • Platelet count: 0.66 (P=.0144).

Limitations

  • Inpatients only.
  • Missing HbA1c data for 35.7%.
  • No data for >7 days.