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The Link Between Diabetes and COVID-19 Deaths

Dec 8, 2020
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Olivia Shenouda, PharmD. Candidate, Florida A&M University School of Pharmacy

Study assigned a point system to chronic risk factors that can affect COVID-19 cases, including diabetes, obesity, and cardiometabolic disease.

This study sought to determine the link and the relationship between COVID-19 and patients with diabetes complications and deaths. Diabetes and obesity pose a considerable risk to the immune system needed to fight an infection like SARS-CoV-2. Based on this study’s finding, a scoring system will be made to predict the link between COVID, diabetes, and the risk of deaths.

COVID-19 is a new disease to arise due to a strain of the coronavirus, SARS-CoV-2. Age differences and different risk factors affect the risk of morbidity and mortality caused by this disease. Some sources proved that infections are higher in smokers than in non-smokers, because smoke lowers their respiratory immunity. In addition to a behavioral factor of hand-to-mouth movement, this increases the risk of contamination.

This study’s data was obtained from negative COVID-19 cases and their demographics from the Mexican epidemiology ministry and examined for connections between COVID-19 positive cases, mortality, and chronic risk factors, including diabetes, obesity, and cardiometabolic disease. At the end of the study, a point system was made to include all the risk factors. s

The research team used the Cox hazard model and regression test to investigate further risk factors predictive of COVID-19-related 30-day mortality risk. Given the availability of SARS-CoV2 negative cases within the dataset, they fitted Cox models for mortality.

There were 177,133 subjects; there were 51,633 subjects observed with COVID-19 and 5,332 deaths. This study’s risk factors are early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD). The risk factors were studied to check the correlation between each factor and the risk of mortality.

It was observed that obesity accounted for 49.5% of the diabetes effect on the COVID-19 mortality rate. Early-onset diabetes was associated with increased risk of hospitalization, while obesity conferred an increased risk for ICU admission and intubation. The researchers’ predictive score for COVID-19 lethality included age ≥65 years, diabetes, early-onset diabetes, obesity, age <40 years, CKD, hypertension, and immunosuppression; it significantly discriminates lethal from non-lethal COVID-19 cases.

Obesity and diabetes have been studied as a factor in the duration of hospitalization due to pulmonary diseases. In the case COVID-19, obesity has always been linked with worse outcomes. Many people with obesity in Mexico dwell in areas of high social vulnerability and poverty, which puts diabetes patients at a higher risk of COVID-related deaths because of poverty, not only because of obesity. Chronic inflammation observed in obesity may lead to the acute inflammatory response triggered by a SARS-CoV-2 infection, that may be linked to a cytokine-mediated reaction. The investigation was done on the role of diabetes and obesity in determining its effect and consequences on SARS-CoV-2 infection, including disease severity and SARS-CoV-2 mortality; using the associations conducted in this study, the research team further made a clinically useful predictive questionnaire for COVID-19 mortality.

The researchers conclude that they have developed a point system model to predict mortality in COVID-19 cases that has good performance. They found that both diabetes and obesity increase the risk of SARS-CoV-2 infection among people in Mexico. Diabetes increases the risk of COVID-19-related mortality, especially in early-onset cases. Obesity is a COVID-19-specific risk factor for both mortality and increased disease severity.

Practice Pearls:

  • There is a significant link between obesity and COVID-19 mortality.
  • Diabetes, especially early onset diabetes, increases the morbidity risk of COVID-19.
  • The researchers developed a predictive model for COVID-19 mortality based on risk factors.


Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, et al. Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):dgaa346. doi:10.1210/clinem/dgaa346

Olivia Shenouda, Fourth-year Doctor of Pharmacy Candidate, Florida A&M University


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