Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2020; 11(12): 644-653
Published online Dec 15, 2020. doi: 10.4239/wjd.v11.i12.644
Diabetic patients with COVID-19 need more attention and better glycemic control
Ming Xu, Wen Yang, Tao Huang, Jun Zhou
Ming Xu, Wen Yang, Tao Huang, Jun Zhou, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Zhou J, Huang T, and Xu M designed the study; Yang W collected the data; Xu M analyzed the data; Xu M and Zhou J completed the manuscript; and all authors approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board (IRB) of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors announced no conflict of interest.
Data sharing statement: Please email the corresponding author for the original data.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Zhou, MD, Surgeon, Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. doctorzhoujun@163.com
Received: April 10, 2020
Peer-review started: April 10, 2020
First decision: September 21, 2020
Revised: October 29, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: December 15, 2020
Processing time: 246 Days and 14.8 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) is a pandemic disease spreading all over the world and has aroused global concerns. The increasing mortality has revealed its severity. It is important to distinguish severe patients and provide appropriate treatment and care to prevent damages. Diabetes is reported to be a common comorbidity in COVID-19 patients and associated with higher mortality. We attempted to clarify the relationship between diabetes and COVID-19 patients’ severity.

AIM

To determine the role of type 2 diabetes in COVID-19 patients.

METHODS

To study the relationship between diabetes and COVID-19, we retrospectively collected 61 patients’ data from a tertiary medical center in Wuhan. All the patients were diagnosed with laboratory-confirmed COVID-19 and admitted to the center from February 13 to March 1, 2020. Patients’ age, sex, laboratory tests, chest computed tomography findings, capillary blood glucose (BG), and treatments were collected and analyzed. Fisher exact test was used for categorical data. Univariate and multivariate logistic regressions were used to explore the relationship between clinical characteristics and patients’ severity.

RESULTS

In the 61 patients, the comorbidity of type 2 diabetes, hypertension, and heart diseases were 24.6% (15 out of 61), 37.7% (23 out of 61), and 11.5% (7 out of 61), respectively. The diabetic group was related to more invasive treatments (P = 0.02) and severe status (P = 0.003). In univariate logistic regression, histories of diabetes (OR = 7.13, P = 0.003), hypertension (OR = 3.41, P = 0.039), and hepatic dysfunction (OR = 7.69, P = 0.002) were predictors of patients’ severity while heart disease (OR = 4.21, P = 0.083) and large lung involvement (OR = 2.70, P = 0.093) also slightly exacerbated patients’ conditions. In the multivariate analysis, diabetes (OR = 6.29, P = 0.016) and hepatic dysfunction (OR = 5.88, P = 0.018) were risk factors for severe patients. Diabetic patients showed elevated BG in 61.7% of preprandial tests and 33.3% of postprandial tests, revealing the limited control of glycemia in COVID-19 patients.

CONCLUSION

A history of type 2 diabetes is correlated with invasive treatments and severe status. Suboptimal glycemic control and hepatic dysfunction have negative effects on severity status and may lead to the exacerbation of COVID-19 patients.

Keywords: Diabetes, COVID-19, Comorbidity, Severity, Glycemic control, Hepatic dysfunction

Core Tip: Type 2 diabetes is one of the most common comorbidities in coronavirus disease 2019 (COVID-19) patients. It is reported to be related to poorer prognosis in other infectious diseases. However, the role of diabetes in COVID-19, a newly pandemic disease, is not clearly investigated. We indicated that diabetes and hepatic dysfunction were risk factors for severe COVID-19 patients. Given that the blood glucose of patients with diabetes and COVID-19 is poorly controlled, glycemic management in COVID-19 patients needs to be optimized.