COVID-19 mortality is higher with new-onset vs established diabetes

  • Li H & al.
  • Diabetes Obes Metab
  • 29 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Mortality is higher with newly diagnosed diabetes vs with known diabetes, prediabetes, or normoglycemia among hospitalized patients with COVID-19.

Why this matters

  • This study is the first to look at the association of COVID-19 and mortality using laboratory-measured glycemia.

Study design

  • Retrospective study of 453 patients admitted to a Wuhan hospital with laboratory-confirmed COVID-19, January 22-March 17, 2020.
  • Patient groups:
    • Normoglycemia (n=132).
    • Hyperglycemia (n=129; fasting glucose, 5.6-6.9 mmol/L; and/or HbA1c, 5.7%-6.4%). 
    • Newly diagnosed diabetes (n=94; fasting glucose, ≥7 mmol/L; and/or HbA1c, ≥6.5%).
    • Known diabetes (n=98).
  • Funding: National Natural Science Foundation of China; others.

Key results

  • Proportions admitted to ICU: 
    • Newly diagnosed diabetes: 11.7%.
    • Hyperglycemia: 6.2%.
    • Known diabetes: 4.1%. 
    • Normoglycemia: 1.5% (P=.008).
  • Proportions requiring invasive mechanical ventilation (IMV):
    • Newly diagnosed diabetes: 11.7%. 
    • Hyperglycemia: 4.7%. 
    • Known diabetes: 9.2%. 
    • Normoglycemia: 2.3% (P=.018).
  • During mean follow-up of 29.5 days, 39 died.
  • With adjustments for age, sex, smoking, systolic BP, total cholesterol, antihypertensive and lipid-lowering agent use, ICU admission, and IMV, mortality HRs (95% CIs) vs normoglycemia:
    • Newly diagnosed diabetes: 7.21 (2.18-32.1).
    • Hyperglycemia: 3.27 (0.63-17.1).
    • Known diabetes: 6.06 (1.32-27.8).
  • With further adjustment for glucose-lowering drug and corticosteroid use, mortality HRs (95% CIs) vs normoglycemia:
    • Newly diagnosed diabetes: 5.63 (1.22-26.0). 
    • Hyperglycemia: 2.64 (0.50-14.0). 
    • Known diabetes: 8.76 (1.78-43.2).

Limitations

  • Potential unmeasured confounders.
  • Some missing HbA1c data.