The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID-19

Link to article at PubMed

Xu Z, et al. J Diabetes 2020.

ABSTRACT

BACKGROUND: Although T2DM patients with COVID-19 develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with anti-hyperglycemic drugs and glucocorticoids is unclear.

METHODS: From 1584 COVID-19 patients, 364 severe/critical COVID-19 patients with clinical outcome were enrolled for the final analysis and patients without pre-existing T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical-status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes.

RESULTS: Of 364 enrolled severe COVID-19 inpatients, 114 (31.3%) cases had a history of T2DM. 27(23.7%) cases died in T2DM patients, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury, compared with non-DM patients. In severe COVID-19 patients with T2DM, we demonstrate a higher risk of all-cause fatality with glucocorticoid treatment (Adjusted HR, 3.61; 95%CI, 1.14-11.46; P = 0.029), and severe hyperglycemia (FPG ≥11.1 mmol/L) (Adjusted HR, 11.86; 95%CI, 1.21-116.44; P = 0.034).

CONCLUSIONS: T2DM status aggravated the clinical condition of COVID-19 patients and increased their critical illness risk. Poor fasting blood glucose (≥ 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID-19. This article is protected by copyright. All rights reserved.

PMID:32638507 | DOI:10.1111/1753-0407.13084

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