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Diabetes and Its Contributions to Early COVID-19 Outcomes

May 22, 2021
 
Editor: Steve Freed, R.PH., CDE

Author: Joan Prifti, PharmD. Candidate, LECOM College of Pharmacy

Patients with diabetes and COVID-19 had poorer early outcomes and were more likely to die within 14 days of hospitalization than those without diabetes.  

Obesity increases the chance of someone being diagnosed with diabetes, and people with diabetes face a higher chance of contracting the COVID-19 virus and experiencing severe complications. Researchers conducted this study to understand which type of people with or without diabetes or obesity were more prevalent in being admitted to the Intensive Care Unit, needing mechanical ventilation, and dying within 14 days. They also wanted to evaluate if hospitalized patients with diabetes were more likely to experience poor early outcomes. 

 

In the study, they used the data from Massachusetts General Hospital (MGH) COVID-19 Data Registry; MGH had the highest number of cases of patients hospitalized with COVID-19 in Massachusetts during the study period. The data was gathered for six weeks. Approximately 450 patients were included in the study. The patients included in this study were followed for 14 days to evaluate the number of patients sent to the ICU, patients who needed mechanical ventilation, and patients who died during those 14 days. Out of 450 patients, about 175 had diabetes, mainly T2D. Their hypothesis to test was that severe COVID-19 cases were associated with poor glycemic control in patients with diabetes. Poor glycemic control was categorized for patients with A1C more significant than 9%, and superior glycemic control was less than 7%. There was a higher proportion of patients with diabetes who also had obesity, 51%, compared to patients without diabetes, only 38%. They used a t-test to compare means, and x^2 was used to compare proportions. They conducted a multivariable logistic regression to associate diabetes and obesity with the primary outcome.  

During the first 14 days after the presentation to care, about 156 patients were admitted to the ICU, about 129 people required mechanical ventilation, and unfortunately, about 49 people had died. When comparing patients with or without diabetes, approximately 42.1% of those who had diabetes were admitted to the ICU compared to 29.8% who did not have diabetes. About 37% of patients with diabetes required mechanical ventilation, while only 23.2% of patients without diabetes required mechanical ventilation. About 15.9% of patients with diabetes died, and only 7.9% of those who did not have diabetes. With the multivariable logistic regression, it was concluded that patients with BMI of 30-34.9 kg/m^2 were associated with greater odds of ICU admission (2.20 [1.14–4.27]) and mechanical ventilation (2.32 [1.15–4.68]). Patients with a BMI greater than 35 kg/m^2 were associated with greater ICU admission odds only (2.11 [1.09–4.09]). It was  concluded that even patients without diabetes but with an increasing BMI category were associated with increased ICU admission and required mechanical ventilation.   

In this study, it was found that patients with diabetes and/or obesity compared to patients without it have a higher prevalence of getting severe complications from COVID-19. They found that patients with diabetes were associated with an increased odds of ICU admission of 1.6 fold, an increase of odds of requiring mechanical ventilation of 2.0 fold, and 2.0 fold of deaths during the 14 days from presentation to care. Obesity was associated with 2.2-fold increased odds of ICU admission and 2.1-fold increased odds of mechanical ventilation. This study will help other hospitals understand the connection between diabetes and obesity with COVID-19. A weakness of this study was the small sample size, which could have affected detecting differences between patients who were hospitalized but did not have any glycemic control lab data. 

Practice Pearls: 

  • People with diabetes and/or obesity with COVID-19 are at higher risk for poor early outcomes. 
  • More than half of the patients that were hospitalized with COVID-19 had diabetes. 
  • Patients with obesity with an increased BMI of 30-34.9 kg/m^2 were associated with increased ICU admission and required mechanical ventilation, while greater than 35 kg/m^2 were only associated with mechanical ventilation. 

 

Jacqueline Seiglie, Jesse Platt, et al. Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19. American Diabetes Association. 1 Aug 2020. Web. 2 Sept., 2020.  

Matthieu Wargny, Pierre Gourdy, et al. Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study. American Diabetes Association. 26 Aug 2020. 2 Sept., 2020 

 

Joan Prifti, PharmD. Candidate, LECOM College of Pharmacy