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Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy.
Mirani, Marco; Favacchio, Giuseppe; Carrone, Flaminia; Betella, Nazarena; Biamonte, Emilia; Morenghi, Emanuela; Mazziotti, Gherardo; Lania, Andrea Gerardo.
  • Mirani M; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy marco.mirani@humanitas.it.
  • Favacchio G; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Carrone F; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Betella N; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Biamonte E; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Morenghi E; Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Mazziotti G; Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
  • Lania AG; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Diabetes Care ; 43(12): 3042-3049, 2020 12.
Article in English | MEDLINE | ID: covidwho-836139
ABSTRACT

OBJECTIVE:

Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients. RESEARCH DESIGN AND

METHODS:

This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality.

RESULTS:

Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95; P = 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35; P = 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38; P = 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55; P = 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42; P = 0.04) but not with type 2 diabetes (P = 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L; P = 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase; P = 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95; P = 0.001) and ß-blockers (aHR 3.20, 95% CI 1.50-6.60; P = 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92; P = 0.042).

CONCLUSIONS:

Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Coronavirus / Diabetes Mellitus, Type 2 / Dipeptidyl-Peptidase IV Inhibitors / Pandemics Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: Diabetes Care Year: 2020 Document Type: Article Affiliation country: Dc20-1340

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Coronavirus / Diabetes Mellitus, Type 2 / Dipeptidyl-Peptidase IV Inhibitors / Pandemics Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: Diabetes Care Year: 2020 Document Type: Article Affiliation country: Dc20-1340