New Data on COVID-19 Patients With Diabetes: 20% Die Within 28 Days of Hospital Admission

iabetic COVID-19 patients face high mortality; recovery linked to age, glucose levels, and treatment type.

Updated results from the CORONADO study, analyzing the outcomes of patients with diabetes admitted to hospital with COVID-19, shows that one in five patients die within 28 days while around half are discharged. The study is published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]), and is by Professor Bertrand Cariou and Professor Samy Hadjadj, diabetologists at l’institut du thorax, University Hospital Nantes, INSERM, CNRS, and University of Nantes, France, and colleagues.

In May 2020, preliminary results from CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes), with a smaller sample size, showed that 10% of patients with diabetes and COVID-19 died within 7 days of hospital admission.

This updated analysis included 2796 participants from 68 centers across France: almost two-thirds (64%) were men, mean age 70 years, with median body mass index of 28 kg/m² (falling into the overweight range). Microvascular and macrovascular diabetic complications were found in 44% and 39% of participants, respectively.

Within 28 days, 1404 (50%) of the patients were discharged from the hospital with a median duration of hospital stay of 9 days, while 577 participants died (21%). Of the remaining patients, 12% remained hospitalized at day 28, while 17% had been transferred to facilities different from their initial hospital.

Computer modeling revealed various factors such as younger age, routine diabetes therapy with the drug metformin, and longer symptom duration on admission were associated with a higher chance of discharge from the hospital.

Indicators Linked to Increased Mortality

History of microvascular complications, routine anticoagulant therapy (to prevent blood clots), shortness of breath on admission, abnormal levels of liver enzymes, higher white blood cell counts and higher levels of the systemic inflammatory marker C-reactive protein were all associated with a lower chance of discharge and a higher risk of death. Patients whose diabetes was regularly treated with insulin (possibly indicating a more advanced state of diabetes) were at a 44% increased risk of death compared with those not treated with insulin.

An unusual finding from this study was a 42% increased risk of death for patients with diabetes receiving statin treatment for high cholesterol – however, the authors make clear since this is an observational study, it is difficult to make definite conclusions about any relationship with statins, or any other treatment.

The study also found that long term blood sugar control assessed with pre-admission or admission glycated hemoglobin (HbA1c) did not impact on the fate of COVID-19 patients, with no significant association with death or with discharge within 28 days. In contrast, an increased level of plasma glucose on admission was a strong predictor of death and, consistently, of a lower chance of discharge.

The authors conclude: “The identification of favorable variables associated with hospital discharge and unfavorable variables associated with death can lead to patient reclassification and help to use resources adequately according to individual patient profile.”

Reference: “Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study” by Matthieu Wargny, Louis Potier, Pierre Gourdy, Matthieu Pichelin, Coralie Amadou, Pierre-Yves Benhamou, Jean-Baptiste Bonnet, Lyse Bordier, Olivier Bourron, Claude Chaumeil, Nicolas Chevalier, Patrice Darmon, Blandine Delenne, Delphine Demarsy, Marie Dumas, Olivier Dupuy, Anna Flaus-Furmaniuk, Jean-François Gautier, Anne-Marie Guedj, Nathalie Jeandidier, Etienne Larger, Jean-Philippe Le Berre, Myriam Lungo, Nathanaëlle Montanier, Philippe Moulin, Françoise Plat, Vincent Rigalleau, René Robert, Dominique Seret-Bégué, Pierre Sérusclat, Sarra Smati, Jean-François Thébaut, Blandine Tramunt, Camille Vatier, Fritz-Line Velayoudom, Bruno Vergès, Patrice Winiszewski, Audrey Zabulon, Pierre-Antoine Gourraud, Ronan Roussel, Bertrand Cariou and Samy Hadjadj for the CORONADO investigators, 17 February 2021, Diabetologia.
DOI: 10.1007/s00125-020-05351-w

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