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New Study Reveals Diabetes is Among the Top Three COVID-19 Comorbidities 

Jun 2, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Stephen Rubano, PharmD. Candidate, USF Taneja College of Pharmacy

Hypertension, obesity, and diabetes found to be the most prevalent comorbidities among 5700 hospitalized patients with COVID-19 in the New York City Area. 

The coronavirus disease of 2019 (COVID-19) swept across the United States from its first confirmed case in Washington State on January 31, 2020, ultimately reaching densely populated areas like New York City, accounting for over thirty percent of the nation’s total cases as of April 20, 2020. Due to pandemic severity, the number of cases in the United States eventually surpassed those reported in both Italy and China. Much of the current research is gravitating toward finding an answer in the form of vaccine or medication. However, researchers also understand the benefits of discovering necessary etiological information such as initial characteristics, clinical presentations, and outcomes of patients hospitalized with COVID-19. For example, a retrospective study performed in China showed that patients hospitalized for COVID-19 were predominantly male with a median age of 56 years. The study also found that 26% of hospitalizations resulted in stays within the intensive care unit (ICU) and an overall mortality rate of 28%. Uncovering evidence indicating the level of risks or susceptibility for different populations can be an essential step to curbing infection rates.       

A similar study conducted at twelve hospitals in New York City used electronic health records (EHRs) to collect data from confirmed COVID-19 cases to describe patient demographics, baseline comorbidities, and clinical outcomes following hospitalization. The study included 5700 patients with the primary endpoint being clinical outcomes such as invasive mechanical ventilation, acute kidney injury (AKI), length of hospital stays, and death. Clinical outcomes were only available for the 2634 patients with definitive outcomes such as discharge or death and considered to have completed their hospital course by the end of the study. Unfortunately, this meant calculated mortality rates did not include patients remaining hospitalized by the study’s conclusion.  The case series also measured secondary outcomes like patient demographics, initial laboratory tests and vital signs, and baseline comorbidities. Race and ethnicity were self-reported by patients falling into prespecified categories at the time of admission. Because patient survival was of interest, the study used the Charlson Comorbidity Index to predict 10-year survival in a total of sixteen separate comorbidities or combinations.   

The study found that among the 2634 patients with definitive outcomes, 373 (14.2%) required ICU treatment, 320 (12.2%) required invasive mechanical ventilation, 81 (3.2%) required kidney replacement therapy, and 553 (21%) died. Mechanical ventilation was likened to drastically higher mortality rates across age groups when compared to similar individuals not needing such intervention. Of note, there were no deaths in patients age 18 years or younger. Finally, researchers calculated an average length of hospital stay of 4.1 days. Of the 5700 patients included in the study, 60.3% were male with a median age of 63 years. The most common comorbidities included hypertension (56.6%), obesity (41.7%), and diabetes (33.8%). Interestingly, patients with diabetes were more likely to be ventilated or placed in ICU care, both shown to have worse clinical outcomes. Finally, the average Charlson Comorbidity index score was 4.1, corresponding to an estimated 10-year survival score of 53% and illustrating the level of burden comorbidities have on these patients.   

As one of the first large case series focusing on hospitalized patients with COVID-19, this study provides critical findings that warrant further investigations. For instance, a significant majority of the patient population were male with preexisting conditions such as hypertension and diabetes, consistent with finding in previous Chinese studies. However, the study included several limitations, one of which is the study population only included patients from New York City and may not be representative of the nation. Second, data retrieved from the hospital EHR databases can be limiting. Finally, the study did not access clinical outcomes for 46.2% of the patients included due to not meeting a definitive outcome. As a result, this likely produced bias in the findings inflating mortality rates, especially within the mechanically ventilated patients.  

Practice Pearls: 

  • The current understanding of COVID-19 etiology is limited, but efforts continue to investigate the fundamental characteristics, clinical presentations, and overall outcome within this patient population. 
  • Data from the study revealed that hypertension, obesity, and diabetes are among the most prevalent comorbidities in patients with COVID-19. 
  • At least two studies describing COVID-19 patient demographics have found an increase in older male patients. 

 

Richardson, Safiya, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 2020. Crossref, doi:10.1001/jama.2020.6775. 

 

Stephen Rubano, PharmD. Candidate, USF Taneja College of Pharmacy 

 

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