Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medications

Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication‍

Peer reviewed and published in Diabetes Care. Retrospective cohort analysis.

By this point most people realize that diabetes presents a significant risk factor for poor outcomes with COVID-19 infection.  There have been multiple studies which are very consistent in the risk diabetes poses to those infected, including several meta-analyses and a meta-regression.  Also important to note is that GLUCOSE CONTROL MATTERS when it comes to COVID-19 outcomes.  This new paper takes a deeper dive into glycemic control and blood pressure medications in patients with and without diabetes and how this relatively unexplored factor impacts COVID-19 outcomes.

This study retrospectively analyzed 903 COVID-19+ (diagnosis both confirmed and clinically made included) patients from a single hospital in Wuhan.  Patients admitted to this hospital were in moderate, severe or critical condition. The only patients admitted had a definitive outcome from their disease (they either were discharged alive or died) between 1/1/20 and 3/7/20. **This is an advantage of this study as multiple papers have had patients enrolled without the final outcome of their disease known during the study period which clearly impacts the final conclusions.  120 patients with diabetes and known glucose lowering medications were included in the study and 71 patients had diabetes and hypertension with known medication history. 

Significant findings:

• There was no significant difference in the initial laboratory findings in patients with diabetes who had confirmed COVID19 and those who had clinically diagnosed COVID-19
• Diabetes was associated with increased odds of death or poor prognosis in all COVID-19+ patients (in-hospital death: OR 2.51 [95% CI 1.53, 4.13]; poor prognosis: OR 2.21 [95% CI 1.50, 3.26]; both P , 0.001
• Patients with diabetes presented with more severe inflammatory responses, acute kidney injury, and secondary infection. **Raises the question - does pre-infection CRP matter?
• Older patients with diabetes are at greater risk for mortality
• Hypertension was the most common comorbidity for patients with diabetes but it had no impact on their prognosis.
• Insulin use was significantly associated with poor prognosis** This has not been examined in prior studies: OR 3.58 [95% CI 1.37-9.35] P, 0.009
• There was no significant difference in outcomes in patients with hypertension who were treated with ACEI/ARB compared to other medications.
  

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.