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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Diabetes patients with comorbidities had unfavorable outcomes following COVID-19: A retrospective study
Shun-Kui Luo, Wei-Hua Hu, Zhan-Jin Lu, Chang Li, Ya-Meng Fan, Qi-Jian Chen, Zai-Shu Chen, Jian-Fang Ye, Shi-Yan Chen, Jun-Lu Tong, Ling-Ling Wang, Jin Mei, Hong-Yun Lu
Shun-Kui Luo, Zhan-Jin Lu, Jian-Fang Ye, Shi-Yan Chen, Jun-Lu Tong, Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
Wei-Hua Hu, Department of Respiratory Medicine, The First Hospital of Jingzhou, Clinical Medical College, Yangtze University, Jingzhou 434000, Hubei Province, China
Chang Li, Department of Cardiology, Hubei No. 3 People’s Hospital of Jianghan University, Wuhan 430033, Hubei Province, China
Ya-Meng Fan, School of Health Sciences, Wuhan University, Wuhan 430071, Hubei Province, China
Qi-Jian Chen, Department of Emergency Medicine, The Fifth Hospital in Wuhan, Wuhan 430050, Hubei Province, China
Zai-Shu Chen, People's Hospital of Jiayu County, Jiayu 437200, Hubei Province, China
Ling-Ling Wang, Department of Gerontology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
Jin Mei, Anatomy Department, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Jin Mei, Central Laboratory, Ningbo First Hospital of Zhejiang University, Ningbo 315010, Zhejiang Province, China
Hong-Yun Lu, Department of Endocrinology and Metabolism, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, Guangdong Province, China
Author contributions: Lu HY and Mei J conceptualized the design of the study, had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Luo SK and Hu WH drafted the manuscript; Lu ZJ, Luo SK did the analysis, Fan YM reviewed the statistical methods; Li C, Chen QJ, Chen ZS, Fan YM collected the data; Lu ZJ, Ye JF, Chen SY, Wang LL and Tong JL recorded the data.
Supported by National Natural Science Foundation of China (General Program), No. 81670815; Guangdong Basic and Applied Basic Research Foundation, No. 2020A1515010124 and No. 2021A1515010695; and Special Fund for Innovation Strategy of Science and Technology plan of Guangdong Province, No. 2019A030317011.
Institutional review board statement: This case series’ study was approved by institutional Ethics Commission of Ningbo First Hospital of Zhejiang University, institutional Ethics Commission of Hubei No. 3 People’s Hospital of Jianghan University, institutional Ethics Commission of People's Hospital of Jiayu County, institutional Ethics Commission of the First Hospital of Jingzhou.
Informed consent statement: Written informed consent was waived by the Ethics Commission of the hospitals for emerging infectious diseases.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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: Hong-Yun Lu, MD, PhD, Chief Doctor, Department of Endocrinology and Metabolism, Zhuhai Hospital Affiliated with Jinan University, No. 79 Kangning Road, Zhuhai 519000, Guangdong Province, China. luhongy@mail.sysu.edu.cn
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: May 12, 2021
Revised: May 25, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 15, 2021
BACKGROUND
Previous studies have shown that diabetes mellitus is a common comorbidity of coronavirus disease 2019 (COVID-19), but the effects of diabetes or anti-diabetic medication on the mortality of COVID-19 have not been well described.
AIM
To investigate the outcome of different statuses (with or without comorbidity) and anti-diabetic medication use before admission of diabetic after COVID-19.
METHODS
In this multicenter and retrospective study, we enrolled 1422 consecutive hospitalized patients from January 21, 2020, to March 25, 2020, at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality. Epidemiological material, demographic information, clinical data, laboratory parameters, radiographic characteristics, treatment and outcome were extracted from electronic medical records using a standardized data collection form. Most of the laboratory data except fasting plasma glucose (FPG) were obtained in first hospitalization, and FPG was collected in the next day morning. Major clinical symptoms, vital signs at admission and comorbidities were collected. The treatment data included not only COVID-19 but also diabetes mellitus. The duration from the onset of symptoms to admission, illness severity, intensive care unit (ICU) admission, and length of hospital stay were also recorded. All data were checked by a team of sophisticated physicians.
RESULTS
Patients with diabetes were 10 years older than non-diabetic patients [(39 - 64) vs (56 - 70), P < 0.001] and had a higher prevalence of comorbidities such as hypertension (55.5% vs 21.4%, P < 0.001), coronary heart disease (CHD) (9.9% vs 3.5%, P < 0.001), cerebrovascular disease (CVD) (3% vs 2.2%, P < 0.001), and chronic kidney disease (CKD) (4.7% vs 1.5%, P = 0.007). Mortality (13.6% vs 7.2%, P = 0.003) was more prevalent among the diabetes group. Further analysis revealed that patients with diabetes who took acarbose had a lower mortality rate (2.2% vs 26.1, P < 0.01). Multivariable Cox regression showed that male sex [hazard ratio (HR) 2.59 (1.68 - 3.99), P < 0.001], hypertension [HR 1.75 (1.18 - 2.60), P = 0.006), CKD [HR 4.55 (2.52-8.20), P < 0.001], CVD [HR 2.35 (1.27 - 4.33), P = 0.006], and age were risk factors for the COVID-19 mortality. Higher HRs were noted in those aged ≥ 65 (HR 11.8 [4.6 - 30.2], P < 0.001) vs 50-64 years (HR 5.86 [2.27 - 15.12], P < 0.001). The survival curve revealed that, compared with the diabetes only group, the mortality was increased in the diabetes with comorbidities group (P = 0.009) but was not significantly different from the non-comorbidity group (P = 0.59).
CONCLUSION
Patients with diabetes had worse outcomes when suffering from COVID-19; however, the outcome was not associated with diabetes itself but with comorbidities. Furthermore, acarbose could reduce the mortality in diabetic.
Core Tip: Previous studies have shown that diabetes mellitus is a common comorbidity of coronavirus disease 2019 (COVID-19), but the effects of diabetes or antidiabetic medication on the mortality of COVID-19 have not been well described. This retrospective and multiple-center study investigate the outcome of different statuses (with or without comorbidity) and antidiabetic medication use before admission of diabetic after COVID-19.
