New research has found that one in ten COVID-19 patients with diabetes dies within seven days of hospital admission
Research, published in Diabetologia, shows that 65% of COVID-19 patients with diabetes admitted to hospital are men with an average age of 70 years. Worse blood sugar control did not seem to impact a patient’s outcome, however, the presence of diabetic complications, increasing age and increased BMI were found to be associated with a higher risk of needing mechanical ventilation and risk of death.
The CORONADO study analysed 1,317 patients admitted to 53 French hospitals between 10th and 31st March. 89% of the hospitalised subjects had type 2 diabetes and only 3% had type 1 diabetes, with other types of diabetes in the remaining cases. In 3% of cases, diabetes was actually diagnosed during hospitalisation for COVID-19.
The group of patients aged 75 years+ were 14 times more likely to die than younger patients aged under 55 years, while patients 65-74 years old were three times more likely to die than those under 55 years.
Across all patients in this study, by day 7 one in five had been intubated and placed on a ventilator in intensive care, and one in 10 had died. A further 18% had been discharged home at this point.
The presence of the respiratory condition obstructive sleep apnoea almost tripled the risk of death at 7 days, as did the presence of dyspnoea symptoms (shortness of breath).
Increased BMI raised the risk of needing intubation/ventilation or death at day 7 – women were 25% less likely to reach this point than men. However, when looking at death only, men were not statistically more likely to die at day 7 than women.
The authors say: “The risk factors for severe form of COVID-19 are identical to those found in the general population: age and BMI.”
They add: “Elderly populations with long-term diabetes with advanced diabetic complications and/or treated obstructive sleep apnoea were particularly at risk of early death, and might require specific management to avoid infection with the novel coronavirus. BMI also appears as an independent prognostic factor for COVID-19 severity in the population living with diabetes requiring hospital admission. The link between obesity and COVID-19 requires further study.”
There were no deaths in patients under 65 years old with type 1 diabetes, but there were only 39 patients with type 1 diabetes in this study. Research is ongoing to establish the effect of COVID-19 in this specific population.
Microvascular and macrovascular complications
Microvascular complications (eyes, kidneys and nerves) were found in 47% of the subjects, while 41% presented macrovascular complications (arteries of the heart, brain, legs). The presence of microvascular or macrovascular complications more than doubled the risk of death at day 7.
The study confirmed that insulin and other treatments for modifying blood sugar are not a risk factor for severe forms of COVID-19 and should be continued in patients with diabetes.
By Professor Bertrand Cariou and Professor Samy Hadjadj, diabetologists at l’institut du thorax, University Hospital Nantes, INSERM, CNRS, and University of Nantes, France, and colleagues.