More than 1 in 10 diabetic patients hospitalized with COVID-19 die within a week and need nearly a third Mechanical ventilation, New study show.
French Coronavirus SARS-CoV-2 and Diabetes Results (CoronadoThe study also found that Body Mass Index (BMI) was independently associated with 7-day mortality or intubation, but A1c And the use of renin-angiotensin-aldosterone system (RAAS) blockers and dipeptidyl peptidase-4 inhibitors was not.
Diabetes-related complications and the presence of the elderly also increased the risk of death.
The survey results are Published online May 29 Diabetes Bertrand Cariou, MD, PhD, Department of Endocrinology, Hôpital Guillaume et René Laennec, Nantes, France, and colleagues.
First study to examine certain characteristics on admission
Previous studies have linked diabetes to worse outcomes with COVID-19, but this is the first to examine certain characteristics before and during hospitalization that predict worse outcomes among people with diabetes Said research co-author Samy Hadjadj, MD Medscape Medical News..
“Before the Coronado study, everything was diabetes. [patients] It’s the same. ‘Now, risk, age, gender, BMI, complications, and [obstructive sleep apnea] Obviously “a very high risk situation,” said Hajaj, the same agency as Kariu.
Another clinical message was: “Even in diabetes, each increase in BMI was associated with an increased risk of intubation and / or death 7 days after hospitalization for COVID-19. Is a really important population to keep and pay attention to virus avoidance. “
But he warned about the discovery of A1c. “Although A1c may be associated with hospital admissions, other factors that go well beyond A1c can affect prognosis as soon as a patient is admitted. Surprisingly, but with reasonable inference I can explain this. “
In addition, Hajadi said no clear signs of drug use have been identified.
“Insulin It is not suspected that there are closely related adverse effects of COVID-19. RAAS blockers are not harmful, High blood pressure“This is also a comorbidity in diabetics,” he said (none of the patients studied was taking sodium-glucose cotransporter-2 inhibitors or glucagon-like peptide receptor agonists).
In addition, high BMI is emerging as a major risk factor
The study included 1317 people with diabetes and COVID-19 confirmed to have been admitted to 53 French hospitals between 10-31 March 2020. Type 2 diabetes, 3% Type 1 diabetes, And 3.1% were newly diagnosed on admission. The average age was 69.8.
Diabetes-related disorders on admission were reported in 11.1% of all participants. These included 132 episodes of severe hyperglycemia, including 40 of ketosis, 19 of which were ketoacidosis and 14 were hypoglycemic events. severe anorexia Reported at 6.3%.
Tracheal intubation for mechanical ventilation and / or death within 7 days of hospitalization, a composite primary endpoint, occurred in 29% of patients (n = 382).
Of the secondary outcomes, 31.1% (n = 410) were admitted to the intensive care unit within 7 days of admission, of which 20.3% (n = 267) required tracheal intubation for mechanical ventilation.
On day 7, 10.6% (n = 140) died and 18.0% (n = 237) were discharged.
In a univariate analysis, the main outcome was more frequent in men (69.1% vs 63.2%; P = .0420) and those taking RAAS blockers (61.5% vs. 55.3%; P = .0386). Median BMI was significantly higher in patients with major outcomes (29.1 vs 28.1 kg / m2)2; P = .0009),
Other pre-hospital features associated with day 7 mortality risk include age, hypertension, micro- and macrovascular diabetes-related complications, and heart failure And treated Obstructive sleep apnea..
More than 40% of hospitalized patients had these complications. Of the patients analyzed, microvascular complications (eyes, kidneys, and neuropathy) were present in 47%, and macrovascular complications (heart, brain, and leg arteries) were present in 41%.
Encouragingly, there were no deaths in people under the age of 65 with type 1 diabetes, but only 39 participants had type 1 diabetes. Other studies are underway to establish the effects of COVID-19 in this particular population, the researchers say.
Among the previous medicines, Metformin Insulin use, RAAS blockers, beta blockers, loop diuretics, and mineralocorticoid receptor antagonists were associated with death on day 7, but findings of drug use did not reach statistical significance.
When asked about the protective effects of metformin (odds ratio, 0.80; P = .4532), Some experts Due to the risk of lactic acidosis he advised to stop it in the COVID-19 setting, Hajaj said he was not necessarily going to stop it in all patients with COVID-19, but “Don’t do that in a serious situation,” he said.
During the analysis, “Some new messages may appear.”
After adjusting for age and gender, BMI was significantly and positively associated with primary outcome (P = .0001) No death on day 7 (P = .1488), A1c was not associated with either outcome.
In a multivariate analysis involving prehospital characteristics, BMI was the only independent prehospital predictor associated with primary outcome (adjusted odds ratio, 1.28) and a factor independently associated with mortality risk on day 7. Included age, history of diabetic complications, and treatment of obstructive sleep apnea.
Also, after adjusting for age and gender, plasma glucose levels at admission were significantly and positively associated with both primary outcomes (P = .0001) and death on day 7 (P = .0059).
In multivariate analysis, the hospitalization characteristics that predicted the main outcomes were dyspnea, lymphopenia, increased aspartate aminotransferase, and increased C-reactive protein.
Hajaj said his team is currently “focusing on specific risk factors. obesity, Age, vascular complications, drug treatments … for deeper analysis. “
“I’m looking forward to analyzing the data on in-hospital stays up to 28 days after admission. There may be some new messages popping up,” he said.
However, for the time being, “ Elderly people treated for long-term diabetes mellitus and / or obstructive sleep apnea with advanced diabetes-related complications are at particular risk of premature death and have been identified to avoid new coronavirus infections. Management may be needed, ”the researchers stress. ..
This study was funded by the Fondation Francophone de Recherche sur le Diabète, with the support of Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly, and Fédération Françaisedes Diabétiques. Societe Franco Fondue Diabate. And Air Liquide Healthcare international. Hadjadj receives grants, personal fees, and / or non-financial support from AstraZeneca, Bayer, Boehringer Ingelheim, Dino Sante, Eli Lilly, LVL, MSD, Novartis, Pierre Fabre Sante, Sanofi, Servier, Valbiotis I am reporting.
Diabetes. Published May 29, 2020 Online. Full text
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