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COVID-19 patients with diabetes mellitus end up worse off

08 Jun 2020

A recent study suggests a link between diabetes mellitus and poor outcomes among COVID-19 patients, including greater disease severity and increased risk of death.

Researchers reviewed the medical records of 258 consecutive COVID-19 patients (median age, 64 years; 53.5 percent male) with or without diabetes who had been hospitalized at the West Court of Union Hospital in Wuhan, China. They obtained and analysed clinical features, treatment strategies, and prognosis data.

Of the patients, 63 had diabetes. Common symptoms included fever (82.2 percent), dry cough (67.1 percent), polypnea (48.1 percent), and fatigue (38 percent). Patients with vs without diabetes had markedly greater leucocyte and neutrophil counts, as well as higher levels of fasting blood glucose, serum creatinine, urea nitrogen, and creatine kinase isoenzyme MB at admission.

A greater proportion of COVID-19 patients with diabetes developed severe or critical disease (p=0.028), with more complications, such as respiratory distress (38.1 percent vs 19.5 percent; p=0.001) and acute cardiac injury (14.5 percent vs 5.1 percent; p=0.016).

Severe disease subtype was defined as meeting one of the following criteria: (1) respiratory distress with respiratory frequency ≥30/min; (2) pulse oximeter oxygen saturation ≤93 percent at rest; (3) oxygenation index ≤300 mm Hg. Critically ill subtype followed the aforementioned criteria plus one of the following conditions: (1) need of mechanical ventilation due to respiratory failure, (2) shock, or (3) presence of multiple organ failure requiring transfer to intensive care unit.

Diabetic patients were also more likely to receive antibiotic therapy (74.6 percent vs 59.0 percent; p=0.026) and noninvasive and invasive mechanical ventilation (p=0.037). The number of deaths was also higher than among patients without diabetes (11.1 percent vs 4.1 percent).

Cox proportional hazard analysis confirmed that fatality rate due to COVID-19 was higher in the presence of diabetes (adjusted hazard ratio [aHR], 3.64, 95 percent confidence interval [CI], 1.09–12.21) and fasting blood glucose (aHR, 1.19, 95 percent CI, 1.08–1.31).

The present data underscore the importance of providing stronger personal prophylactic strategies for patients with diabetes and considering more intensive surveillance and treatment when they are infected with SARS-CoV-2, especially older adults and individuals with pre-existing medical conditions, according to the researchers.

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