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Diabetic patients with COVID-19 need more attention and better glycemic control

Ming Xu¹, Wen Yang¹, Tao Huang¹

¹Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.

World Journal of Diabetes

|January 1, 2021

Insights

Type 2 diabetes in COVID-19 patients is linked to more severe illness and invasive treatments. Poor blood sugar control and liver dysfunction worsen outcomes for diabetic individuals with COVID-19.

Area of Science:

Infectious Diseases
Endocrinology
Critical Care Medicine

Background:

Coronavirus disease 2019 (COVID-19) poses a global health threat with significant mortality.
Diabetes is a prevalent comorbidity in COVID-19 patients, associated with increased fatality.
Understanding the impact of diabetes on COVID-19 severity is crucial for patient management.

Purpose of the Study:

To investigate the association between type 2 diabetes and the severity of COVID-19.
To identify clinical characteristics that predict severe outcomes in COVID-19 patients with diabetes.

Main Methods:

Retrospective analysis of 61 laboratory-confirmed COVID-19 patients admitted to a tertiary medical center.
Data collected included demographics, comorbidities, laboratory findings, chest CT scans, blood glucose levels, and treatments.
Statistical analyses involved Fisher exact test and univariate/multivariate logistic regressions.

Main Results:

Diabetes was present in 24.6% of patients and significantly correlated with more invasive treatments (P=0.02) and severe status (P=0.003).
Multivariate analysis identified diabetes (OR=6.29, P=0.016) and hepatic dysfunction (OR=5.88, P=0.018) as independent risk factors for severe COVID-19.
Diabetic patients exhibited suboptimal glycemic control, with elevated preprandial (61.7%) and postprandial (33.3%) blood glucose levels.

Conclusions:

Type 2 diabetes is a significant risk factor for severe COVID-19 and necessitates more intensive medical interventions.
Hepatic dysfunction and poor glycemic control in diabetic patients exacerbate COVID-19 severity.
Early identification and management of comorbidities like diabetes are vital for improving COVID-19 patient outcomes.

Read full analysis

Abstract

Background:

Coronavirus disease 2019 (COVID-19) is a pandemic disease spreading all over the world and has aroused global concerns. The increasing mortality has revealed its severity. It is important to distinguish severe patients and provide appropriate treatment and care to prevent damages. Diabetes is reported to be a common comorbidity in COVID-19 patients and associated with higher mortality. We attempted to clarify the relationship between diabetes and COVID-19 patients' severity.

Aim:

To determine the role of type 2 diabetes in COVID-19 patients.

Methods:

To study the relationship between diabetes and COVID-19, we retrospectively collected 61 patients' data from a tertiary medical center in Wuhan. All the patients were diagnosed with laboratory-confirmed COVID-19 and admitted to the center from February 13 to March 1, 2020. Patients' age, sex, laboratory tests, chest computed tomography findings, capillary blood glucose (BG), and treatments were collected and analyzed. Fisher exact test was used for categorical data. Univariate and multivariate logistic regressions were used to explore the relationship between clinical characteristics and patients' severity.

Results:

In the 61 patients, the comorbidity of type 2 diabetes, hypertension, and heart diseases were 24.6% (15 out of 61), 37.7% (23 out of 61), and 11.5% (7 out of 61), respectively. The diabetic group was related to more invasive treatments (P = 0.02) and severe status (P = 0.003). In univariate logistic regression, histories of diabetes (OR = 7.13, P = 0.003), hypertension (OR = 3.41, P = 0.039), and hepatic dysfunction (OR = 7.69, P = 0.002) were predictors of patients' severity while heart disease (OR = 4.21, P = 0.083) and large lung involvement (OR = 2.70, P = 0.093) also slightly exacerbated patients' conditions. In the multivariate analysis, diabetes (OR = 6.29, P = 0.016) and hepatic dysfunction (OR = 5.88, P = 0.018) were risk factors for severe patients. Diabetic patients showed elevated BG in 61.7% of preprandial tests and 33.3% of postprandial tests, revealing the limited control of glycemia in COVID-19 patients.

Conclusion:

A history of type 2 diabetes is correlated with invasive treatments and severe status. Suboptimal glycemic control and hepatic dysfunction have negative effects on severity status and may lead to the exacerbation of COVID-19 patients.

Keywords:

COVID-19 Comorbidity Diabetes Glycemic control Hepatic dysfunction Severity

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