Diabetes with COVID-19 was a significant risk factor for mortality, mechanical ventilation, and renal replacement
Hirotsugu Suwanai1, Masato Kanda2,3, Kazuharu Harada4
1Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan.
Insights
Patients with diabetes mellitus face significantly higher risks of severe outcomes, including in-hospital mortality and intensive care unit (ICU) admission, when hospitalized with coronavirus disease 2019 (COVID-19). This highlights diabetes as a critical risk factor for adverse COVID-19 outcomes in Japan.
Area of Science:
- Infectious Diseases
- Endocrinology
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) has posed a global health challenge.
- Diabetes mellitus is a common comorbidity associated with increased COVID-19 severity.
- Understanding the impact of diabetes on COVID-19 inpatient outcomes is crucial for clinical management.
Purpose of the Study:
- To investigate the effect of COVID-19 on hospitalized patients with diabetes mellitus.
- To identify specific severe clinical outcomes associated with diabetes in COVID-19 patients.
- To assess diabetes as a risk factor for adverse COVID-19 outcomes in Japan.
Main Methods:
- Multicenter retrospective cohort study involving 38 hospitals in Chiba, Japan.
- Data collected from February 1, 2020, to November 31, 2021, using Diagnosis Procedure Combination (DPC) data.
- Inclusion criteria: hospitalized patients aged 18+, treated with diabetic medication; exclusion criteria: pregnancy, no diabetic medication.
Main Results:
- A total of 10,776 patients were included (3,097 diabetic, 7,679 non-diabetic).
- Diabetic patients were older, had higher BMI, and experienced longer hospital stays.
- Higher rates of in-hospital mortality, mechanical ventilation, ICU admission, hemodialysis (HD), and continuous hemodiafiltration (CHDF) were observed in the diabetes group, even after adjustments.
Conclusions:
- Diabetes mellitus is a significant risk factor for severe clinical outcomes in hospitalized COVID-19 patients.
- Adverse outcomes include increased in-hospital mortality, need for mechanical ventilation, ICU admission, and renal replacement therapies (HD, CHDF).
- Findings emphasize the importance of managing diabetes in COVID-19 patients to mitigate severe complications.
Abstract:
We conducted a multicenter retrospective cohort study across 38 hospitals in Chiba, Japan, between February 1, 2020 and November 31, 2021 to investigate the effect of coronavirus disease 2019 (COVID-19) on patients with diabetes mellitus receiving inpatient care. We collected inpatient medical data through Diagnosis procedure combination (DPC), the diagnoses and payment system of medical insurance, from each hospital. We excluded patients younger than 18 years, those who were pregnant, and those who had diabetes but were not treated with diabetic medication. A total of 10,776 patients were included: 7,679 in the non-diabetic (control) group and 3,097 in the diabetic group. Patients in the diabetic group were older and had a higher body mass index (BMI) than those in the control group. In the diabetes group, 88.4% of the patients were treated with insulin therapy and 44.2% were treated with oral hypoglycemic agents. The length of hospital days was significantly longer in the diabetes group. The in-hospital mortality rate was significantly higher especially between 50 and 59 years old. The rates of in-hospital mortality, mechanical ventilation, intensive care unit (ICU) admission, renal replacement therapies such as hemodialysis (HD), and continuous hemodiafiltration (CHDF) were all higher, even after adjusting for age, sex, BMI, and ambulance use. In conclusion, diabetes was a significant risk factor of the severe clinical outcomes especially for in-hospital mortality, mechanical ventilation usage, ICU admission, HD, and CHDF in Japan.
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