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Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19
Jacqueline Seiglie1,2, Jesse Platt3,4, Sara Jane Cromer5,2
1Diabetes Unit, Massachusetts General Hospital, Boston, MA jseiglie@partners.org.
Insights
Diabetes significantly increases the risk of severe outcomes in hospitalized coronavirus disease 2019 (COVID-19) patients, including ICU admission, mechanical ventilation, and death, even after accounting for obesity. These findings highlight the importance of managing diabetes in COVID-19 care.
Area of Science:
- Medical research
- Infectious diseases
- Endocrinology
Background:
- Diabetes and obesity are common in hospitalized coronavirus disease 2019 (COVID-19) patients.
- The specific impact of diabetes on early COVID-19 outcomes, independent of obesity, requires further investigation.
Purpose of the Study:
- To determine if diabetes is an independent risk factor for adverse early outcomes in hospitalized COVID-19 patients.
- To assess the association between diabetes and outcomes such as intensive care unit (ICU) admission, mechanical ventilation, and 14-day mortality, adjusting for obesity.
Main Methods:
- Analysis of data from the Massachusetts General Hospital (MGH) COVID-19 Data Registry.
- Inclusion of 450 patients hospitalized with COVID-19 between March and April 2020.
- Logistic regression models adjusted for demographic factors, obesity, and comorbidities to evaluate primary outcomes: ICU admission, mechanical ventilation, and 14-day death.
Main Results:
- Diabetes was present in 39.6% of patients (178/450).
- Patients with diabetes had significantly higher rates of ICU admission (42.1% vs. 29.8%), mechanical ventilation (37.1% vs. 23.2%), and 14-day death (15.9% vs. 7.9%) compared to those without diabetes.
- Multivariable analysis confirmed diabetes was associated with increased odds of ICU admission (OR 1.59), mechanical ventilation (OR 1.97), and death (OR 2.02). Obesity was linked to ICU admission and ventilation but not death.
Conclusions:
- Diabetes is a significant risk factor for poor early outcomes in hospitalized COVID-19 patients, independent of obesity.
- These findings underscore the need for tailored patient-centered care strategies for individuals with diabetes who are at risk for COVID-19.
- The results emphasize the critical role of diabetes management in mitigating severe COVID-19 complications.
Objective:
Diabetes and obesity are highly prevalent among hospitalized patients with coronavirus disease 2019 (COVID-19), but little is known about their contributions to early COVID-19 outcomes. We tested the hypothesis that diabetes is a risk factor for poor early outcomes, after adjustment for obesity, among a cohort of patients hospitalized with COVID-19.
Research Design And Methods:
We used data from the Massachusetts General Hospital (MGH) COVID-19 Data Registry of patients hospitalized with COVID-19 between 11 March 2020 and 30 April 2020. Primary outcomes were admission to the intensive care unit (ICU), need for mechanical ventilation, and death within 14 days of presentation to care. Logistic regression models were adjusted for demographic characteristics, obesity, and relevant comorbidities.
Results:
Among 450 patients, 178 (39.6%) had diabetes-mostly type 2 diabetes. Among patients with diabetes versus patients without diabetes, a higher proportion was admitted to the ICU (42.1% vs. 29.8%, respectively, P = 0.007), required mechanical ventilation (37.1% vs. 23.2%, P = 0.001), and died (15.9% vs. 7.9%, P = 0.009). In multivariable logistic regression models, diabetes was associated with greater odds of ICU admission (odds ratio 1.59 [95% CI 1.01-2.52]), mechanical ventilation (1.97 [1.21-3.20]), and death (2.02 [1.01-4.03]) at 14 days. Obesity was associated with greater odds of ICU admission (2.16 [1.20-3.88]) and mechanical ventilation (2.13 [1.14-4.00]) but not with death.
Conclusions:
Among hospitalized patients with COVID-19, diabetes was associated with poor early outcomes, after adjustment for obesity. These findings can help inform patient-centered care decision making for people with diabetes at risk for COVID-19.
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