Diabetes, obesity and COVID-19 disease: An observational study of outcomes among hospitalized patients in Boston, Massachusetts

ABSTRACT

Background: In the United States, diabetes mellitus (DM) is among the most common chronic diseases, with approximately 34.2 million people affected. DM has also emerged as a commonly reported risk factor among people hospitalized with coronavirus disease 2019 (COVID-19). In this study, we sought to evaluate whether people with DM who are hospitalized with COVID-19 were more likely to experience poor early outcomes and whether this association remained after adjustment for obesity status. Methods: We analyzed data from the Massachusetts General Hospital (MGH) COVID-19 Data Registry. The sample included 450 people with PCR-confirmed SARSCoV- 2 infection who were hospitalized at MGH between March 11, 2020 and April 30, 2020. The primary outcomes were (1) admission to the intensive care unit (ICU) and (2) need for mechanical ventilation or death, both within 14 days of presentation to care. Data were obtained by manual chart review and via an EMR-associated database. Logistic regression was used to evaluate the relationship between diabetes and these outcomes. All models were adjusted for age, sex, race, BMI category and key comorbidities. Results: In this study, 178 (39.6%) of 450 participants had DM and 346 (76.9%) were overweight or obese. People with DM were on average older and had a higher BMI than those without DM. A higher percentage of patients with DM were admitted to the ICU (42.1% vs 29.8%, p=0.007) and required mechanical ventilation or died (46.6% vs 27.7%, p< 0.001), compared with patients without DM (Figure 1). In adjusted models, DM was associated with a greater odds of ICU admission (aOR 1.58 [95% CI 1.01- 2.46]) and mechanical ventilation or death (2.15 [1.38-3.34). Obesity was associated with a greater odds of ICU admission (2.15 [1.20-3.86]) but not with mechanical ventilation or death (1.52 [0.87-2.67]). Table 1 provides the model results in full. Conclusion: Diabetes was associated with poor outcomes within 14-days of presentation to care for COVID-19. These findings remained after adjustment for obesity. Our findings can help guide risk mitigation efforts and patient-centered care decision making for people with DM and obesity, particularly in areas of the US that have a high prevalence of DM and obesity and are in early phases of the SARS-CoV-2 outbreak. (Table Presented).