Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study
Kamlesh Khunti,
Pere Domingo,
Josep Franch-Nadal,
Manel Mata-Cases,
Jordi Real,
Didac Mauricio,
Esmeralda Castelblanco,
Emilio Ortega,
Rosa Corcoy,
Mònica Gratacòs,
Francesc Xavier Cos Claramunt,
Ramon Puig-Treserra,
Bogdan Vlacho
Affiliations
Kamlesh Khunti
Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
Pere Domingo
Infectious Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Institut de Recerca Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
Josep Franch-Nadal
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Manel Mata-Cases
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Jordi Real
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Didac Mauricio
Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
Esmeralda Castelblanco
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Emilio Ortega
Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain
Rosa Corcoy
Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
Mònica Gratacòs
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Francesc Xavier Cos Claramunt
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Ramon Puig-Treserra
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Bogdan Vlacho
DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Aim This study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).Design This was a cross-sectional study.Settings We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measures Multiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.Results Overall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.Conclusion The results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.
