Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

Table 1 Demographic characteristics, comorbidities, symptoms, signs, laboratory measurements, radiographic and severity indices of chest infection, and disease outcome observed in coronavirus disease 2019 patients with and without type 2 diabetes; in Dubai

Characteristics	T2D (n = 427)	Without T2D (n = 656)	P valuea
A: Demographics and comorbidities [n (%)]
Gender	No (%)
Male	378 (42.5)	512 (57.5)
Female	49 (25.4)	144 (74.6)	< 0.001
Nationality
United Arab Emirates	23 (59)	16 (41)
Expatriate	404 (38.7)	640 (61.3)	0.009
Hypertension	165/427 (38.6)	88/656 (13.4)	< 0.001
Ischemic heart disease	21/427 (4.9)	3/656 (0.5)	< 0.001
Cardiomyopathy	2/427 (0.5)	0/656	0.155
Heart failure	13/427 (3)	4/656 (0.6)	0.002
COPD	2/427 (0.5)	1/656 (0.2)	0.344
Asthma	10/427 (2.3)	18/656 (2.7)	0.421
B: Symptoms and signs [n (%)]
Fever	358 (85.9)	528 (82.8)	0.105
Cough	303 (72.7)	388 (60.8)	< 0.001
Sore throat	52 (12.5)	150 (23.5)	< 0.001
Running nose/rhinorrhoea	17 (4.1)	40 (6.3)	0.079
Shortness of breath (dyspnoea)	276 (66.2)	250 (39.2)	< 0.001
Chest pain	22 (5.3)	29 (4.5)	0.344
Chills	13 (3.1)	35 (5.5)	0.047
Headache	24 (5.8)	74 (11.6)	< 0.001
Fatigue	92 (22.1)	116 (18.2)	0.071
Malaise	8 (1.9)	15 (2.4)	0.405
Nausea	11 (2.6)	17 (2.6)	0.572
Loss of appetite/anorexia	19 (4.6)	22 (3.4)	0.226
Loss of taste	1 (0.2)	6 (0.9)	0.164
Anosmia/loss of smell	1 (0.2)	6 (0.9)	0.164
Abdominal pain	12 (2.9)	46 (7.2)	0.001
Vomiting	39 (9.4)	47 (7.4)	0.150
Diarrhoea	26 (6.2)	34 (5.3)	0.312
Myalgia	123 (29.5)	180 (28.2)	0.351
Arthralgia/joint pain	1 (0.2)	2 (0.2)	0.635
Dizziness	10 (2.4)	21 (3.3)	0.259
Confusion	4 (1.0)	2 (0.3)	0.216
Skin rash	1 (0.2)	1 (0.2)	0.635
C: Laboratory measurements [mean (± SD)]
Haemoglobin (g/dL)	12.42 (2.07)	13.45 (1.84)	< 0.001
MCV (fL)	85.66 (37.79)	84.54 (7.74)	0.01
WBC (109/L)	9.62 (7.87)	8.31 (7.25)	< 0.001
Lymphocyte (%)	14.57 (8.52)	18.46 (10.08)	< 0.001
Absolute lymphocyte count	1.05 (0.82)	1.26 (0.78)	< 0.001
Random blood glucose (mg/dL)	222.53 (114.59)	119.16 (42.75)	< 0.001
Fasting blood glucose POCT (mg/dL)	192.06 (88.88)	126.77 (48.38)	< 0.001
HbA1C (%)	9.26 (2.44)	5.74 (0.47)	< 0.001
CRP (mg/L)	86.38 (88.05)	50.23 (64.68)	< 0.001
Troponin (ng/mL)	180.10 (917.58)	18.29 (64.11)	< 0.001
D-Dimer (mcg/mL)	4.14 (6.43)	2.46 (5.04)	< 0.001
Pro-calcitonin (ng/mL)	0.97 (4.2)	0.61 (3.18)	< 0.001
Pro-BNP (pg/mL)	1948.56 (4602.46)	1533.62 (6449.57)	0.008
Ferritin (mcg/L)	1526.7 (2153.81)	1231.68 (3268.65)	< 0.001
LDH (U/L)	444.93 (371.05)	355.55 (243.98)	< 0.001
LDH-Peak (U/L)	429.27 (393.39)	366.62 (585.83)	< 0.001
CPK peak (U/L)	597.8 (1090.39)	505.5 (2055.57)	0.022
Creatinine (mg/dL)	1.87 (2.12)	1.16 (1.44)	< 0.001
D: Chest radiographs, ventilation and disease outcome [No (%)]
Normal chest radiograph	16 (3.8)	99 (16.5)	< 0.001
Mild consolidation [1-2 zones]	174 (41.7)	342 (57.1)
Moderate consolidation [2-3 zones]	183 (43.9)	125 (20.9)
Severe consolidation [3-4 zones]	44 (10.6)	33 (5.5)
E: SpO2 on admission
≤ 94	84 (19.7)	64 (9.8)	< 0.001
> 94	343 (80.3)	592 (90.2)
F: Ventilation and/or intubation
O2 mask	58 (13.6)	43 (6.6)	< 0.001
Nasal canula	311 (72.8)	361 (55)	< 0.001
Intubation	42 (9.8)	15 (2.3)	< 0.001
G: Complications & Outcomes
Diabetic keto acidosis	7 (4.5)	0	0.01
Chronic kidney failure	37 (10.5)	16 (3)	< 0.001
Length of hospital stay, mean (days)	14.90 (17.31)	7.49 (10.22)	< 0.001
Death: No (%)	63/427 (14.8)	32/656 (4.9)	< 0.001

^at-test, Mann-Whitney and Chai Square.

COPD: Chronic obstructive pulmonary disease; WBC: White blood cell; CRP: C-reactive protein; LDH: Lactate dehydrogenase; T2D: Type 2 diabetes; MCV: Mean corpuscular volume; POCT: Point of care testing; CPK: Creatine phospho-kinase.

Table 2 The association between demographic characteristics, comorbidities, symptoms, signs, laboratory measurements, radiographic and severity indices of chest infection and disease outcome observed in coronavirus disease 2019 patients with and without type 2 diabetes in Dubai

Characteristics	T2D (n = 427)			Without T2D (n = 656)
	Survivors (n = 364)	Non-survivors (n = 63)	P value	Survivors (n = 624)	Non-survivors (n = 32)	P valuea < 0.001
A: Demographics and comorbidities [n (%)]
Males: No (%)	325 (86)	53 (14)	0.164	484 (94.1)	30 (5.9)	0.072
Females: No (%)	39 (79.6)	10 (20.4)		140 (98.6)	2 (1.4)
Age: Yr (± SD)	50.76 (10.92)	54.86 (12.58)	0.02	38.83 (13.42)	48.58 (12.43)	< 0.001
BMI (±SD)	28.81 (5.53)	28.69 (5.08)	0.841	27.15 (4.95)	28.03 (5.05)	0.400
Hypertension, No (%)	137 (37.6)	28 (44.4)	0.188	77 (12.4)	11 (30.6)	0.005
B: Symptoms and signs [n (%)]
Fever	306 (86.4)	52 (82.5)	0.26	502 (82.8)	26 (81.0)	0.484
Cough	256 (72.3)	47 (74.6)	0.418	359 (59.2)	29 (90.6)	< 0.001
Sore throat	50 (14.1)	2 (3.2)	0.007	146 (24.1)	4 (12.5)	0.093
Dyspnea	224 (63.3)	52 (82.5)	0.002	222 (36.6)	28 (87.5)	< 0.001
Headache	23 (6.5)	1 (1.6)	0.097	73 (12)	1 (3.1)	0.095
C: Laboratory measurements [mean (± SD)]
Hemoglobin (g/dL)	12.69 (2.06)	10.95 (1.36)	< 0.001	13.6 (1.7)	10.7 (1.2)	< 0.001
MCV (fL)	85.98 (41)	83.95 (7.28)	0.815	84.4 (7.6)	86.2 (10)	0.223
WBC (109/L)	9.02 (6.56)	12.86 (12.41)	< 0.001	7.6 (4.75)	18.9 (20.4)	< 0.001
Lymphocytes (%)	15.48 (8.59)	9.55 (6.1)	< 0.001	18.79 (9.7)	13.1 (13.3)	< 0.001
Absolute lymphocyte	1.13 (0.84)	0.57 (0.5)	< 0.001	1.3 (0.7)	1.2 (1.6)	< 0.001
Random glucose (mg/dL)	221.52 (115.69)	227.94 (109.3)	0.442	118.8 (43.6)	124.4 (62.3)	0.026
Fasting glucose (mg/dL)	107.46 (114.85)	118.1 (121.74)	0.191	118.8 (43.6)	52.5 (68)	< 0.001
HbA1C (%)	9.32 (2.4)	8.87 (2.64)	0.13	5.73 (0.5)	5.9 (0.4)	0.586
CRP (mg/L)	76.23 (77.72)	141.1 (116.77)	< 0.001	44.6 (56)	138 (108)	< 0.001
Troponin (ng/mL)	167.19 (990.22)	238.21 (470)	< 0.001	15.9 (64.5)	37.6 (58.4)	< 0.001
D-Dimer (mcg/mL)	3.09 (4.53)	9.56 (10.79)	< 0.001	1.78 (3.84)	8.9 (9.1)	< 0.001
Procalcitonin (ng/mL)	0.83 (4.32)	1.75 (3.45)	< 0.001	0.51 (3.01)	1.9 (4.72)	< 0.001
Pro-BNP (pg/mL)	1225.01 (3572)	3862.9 (6248.31)	0.007	1324.5 (7323)	2109.1 (2985.8)	< 0.001
Ferritin (mcg/L)	1277.9 (1599.2)	2888 (3749)	< 0.001	856.2 (1179)	5549.9 (10016)	< 0.001
LDH (U/L)	416.41 (365.96)	611.04 (360.04)	< 0.001	321.1 (164.7)	785 (521.5)	< 0.001
LDH-Peak (U/L)	402.02 (394.6)	605.2 (339.82)	< 0.001	346.3 (587.3)	644.1 (491.3)	< 0.001
CPK peak (U/L)	464.9 (970.7)	1163.5 (1369.5)	< 0.001	432.8 (2145.6)	1041.2 (1085)	< 0.001
Creatinine (mg/dL)	1.61 (2.01)	3.22 (2.17)	< 0.001	1.02 (1.22)	3.2 (2.55)	< 0.001
D: Chest radiographs, ventilation and disease outcome [n (mean ± SD)]
E: Chest radiograph
Normal X-ray	15 (4.2)	1 (1.6)	0.021	99 (17.4)	0	< 0.001
Mild	156 (43.9)	18 (29)		335 (59)	7 (22.6)
Moderate	152 (42.8)	31 (50)		11 (19.5)	14 (45.2)
Severe	32 (9)	12 (19.4)		23 (4)	10 (32.3)
F: SpO2 on admission
≤ 94	56 (15.4)	28 (44.4)		574 (92.6)	18 (50)	< 0.001
> 94	308 (84.6)	35 (55.6)	< 0.001	46 (7.4)	18 (50)
G: Ventilation and/or intubation
O2 mask	32 (8.8)	26 (41.3)	< 0.001	23 (3.7)	20 (55.6)	< 0.001
Nasal canula	269 (73.9)	42 (66.7)	0.15	340 (54.8)	21 (58.3)	0.408
Intubation	21 (5.8)	21 (33.3)	< 0.001	6 (1.0)	9 (25)	< 0.001
H: Complications & outcomes
Diabetic ketoacidosis	3 (2.3)	4 (14.3)	0.02
Chronic kidney failure	19 (6.4)	18 (31)	< 0.001	11 (2.2)	5 (15.2)	0.002
Length of hospital stay: Mean (SD)	14.47 (17.9)	17.02 (14)	0.005	6.47 (8.53)	32 (20.06)	< 0.001

^at-test, Mann-Whitney and Chai Square.

BMI: body mass index; WBC: White blood cell; CRP: C-reactive protein; LDH: Lactate dehydrogenase; T2D: Type 2 diabetes; MCV: Mean corpuscular volume; CPK: Creatine phospho-kinase.

Table 3 Comparison of the rate of mortality of COVID-19 patients, with and without type 2 diabetes; in successive 5-day intervals of hospital admission, in Dubai

	Total number of patients (n = 1083)	Patients with T2D (n = 427)	Patients without T2D (n = 656)	Ratio: T2D:Non-T2D
0-5 d	15	10	5	3.1
6-10 d	18	12	6	3.1
11-15 d	20	15	5	4.6
16-20 d	8	4	4	1.53
21-25 d	13	9	4	3.5
26-30 d	8	7	1	10.8
> 30 d	13	6	7	1.3
Total	95	63	32	3.1

T2D: Type 2 diabetes.