Diabesity As The Risk Factor For The Need of Intensive Care Unit for the Management of COVID-19

ABSTRACT

Objective: Elderly age is documented as the highest risk factor for the requirement of intensive care in COVID-19 patients. Diabetes and obesity are the risk enhancers in COVID-19. However, there is limited evidence for the modifiable risk factors like body weight as a predictor for the need for Intensive Care Unit (ICU) care in T2DM patients. We evaluated the association of body weight as a predictor of ICU admissions Methods: We evaluated 187 patients T2DM patients (111 males, 76 females), recovered from COVID-19, on follow up for diabetes care, from eight diabetes clinics who had association of the metabolic risk factors with the need for intensive care. Descriptive statistics and Fisher's exact test were performed Results: There were 100 known hypertensives and 140 patients recovered without intensive care. The mean age (years), BMI (kg/m2), HbA1c (%), was 56 (±14, minimum 11, maximum 94, range 83, 95% CI 55 to 58), 27 (±4.7, minimum 17, maximum 44, range 83, 95% CI 27 to 28), 8.1 (±1.6, minimum 4.8, maximum 15, range 10, 95% CI 7.9 to 8.4), respectively. 50 patients (26.7%) at follow up, for diabetes consultation, post COVID-19 had good glycemic control, with HbA1c of less than 7%. 47/187 (25.1%) of the T2DM needed ICU care. 79 (42.2%) patients were age ≥60. Higher proportion with age ≥60, 30.3% (n = 24) required ICU as compared to 21.2% (n = 23) out of 108 patients with age < 60, (relative risk = 1.42, p = 0.17 NS). 125 (66.8%) patients were either overweight or obese (BMI ≥25 kg/m2). Higher proportion with BMI ≥25, 27.2% (n = 34) required ICU as compared to 20.9% (n = 13) out of 62 patients with BMI < 25 kg/m2 (relative risk = 1.29, p = 0.37 NS). Th most frequent associated morbidities in T2DM were, overweight-obesity (n = 125), followed by hypertension (n = 100) and Chronic Kidney Disease (CKD) (n = 12) Conclusion: ICU admission risk was elevated for both elderly age and overweight - obese patients in T2DM patients diagnosed with COVID-19. Our findings reinforce risk imposed by obesity-related metabolic derangements leading to systemic metabolic inflammation (metaflammation). We postulate the need to manage the burden of obesity to reduce the severity of COVID-19. Reduction of body weight would help to mitigate the need of ICU care and free the limited healthcare resources that are already constrained due to COVID-19 and has the potential to improve the outcomes.