Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication
- 1 July 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (7), 1399-1407
- https://doi.org/10.2337/dc20-0660
Abstract
OBJECTIVE 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= 0.001) and elevated C-reactive protein (aOR 1.12 [95% CI 1.00, 1.24];P= 0.043). Insulin usage (aOR 3.58 [95% CI 1.37, 9.35];P= 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.Funding Information
- National Key R&D Program of China (2019YFA0802701, 2018YFA0800700)
- National Natural Science Foundation of China (91957114, 31971066, 31871381, 31671195)
- Family Planning Commission of Wuhan (WX18M02)
This publication has 27 references indexed in Scilit:
- Global trends in diabetes complications: a review of current evidenceDiabetologia, 2018
- Low-grade systemic inflammation: a partial mediator of the relationship between diabetes and lung functionAnnals of Epidemiology, 2018
- Effects of Apelin Peptides on Diabetic ComplicationsCurrent Protein & Peptide Science, 2017
- The vasoprotective axes of the renin-angiotensin system: Physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseasesPharmacological Research, 2017
- 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 CausesPLOS ONE, 2016
- Diabetes and infection: assessing the association with glycaemic control in population-based studiesThe Lancet Diabetes & Endocrinology, 2016
- Cross-Sectional and Prospective Study of Lung Function in Adults With Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) StudyDiabetes Care, 2008
- Cross-Sectional and Prospective Study of Lung Function in Adults With Type 2 DiabetesDiabetes Care, 2008
- Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARSDiabetic Medicine, 2006
- SARS: epidemiologyRespirology, 2003