Preadmission Diabetes-Specific Risk Factors for Mortality in Hospitalized Patients With Diabetes and Coronavirus Disease 2019

Abstract

Objective: To examine whether HbA_1c, outpatient diabetes treatment regimen, demographics, and clinical characteristics are associated with mortality in hospitalized patients with diabetes and coronavirus disease 2019 (COVID-19).

Research design and methods: This was a retrospective cohort analysis of patients with diabetes hospitalized with confirmed COVID-19 infection from 11 March to 7 May 2020 at a large academic medical center in New York City. Multivariate modeling was used to assess the independent association of HbA_1c levels and outpatient diabetes treatment regimen with mortality, in addition to independent effects of demographic and clinical characteristics.

Results: We included 1,126 hospitalized patients with diabetes and COVID-19 for analysis, among whom mean age was 68 years, 50% were male, 75% were Black, mean BMI was 30 kg/m², 98% had type 2 diabetes, mean HbA_1c was 7.5%, and 33.1% died. HbA_1c levels were not associated with mortality in unadjusted or adjusted analyses, but an outpatient regimen with any insulin treatment was strongly predictive. Additionally, age, sex, and BMI interacted such that in all age categories, mortality was higher with increasing BMI in males compared with females.

Conclusions: In this large U.S. cohort of hospitalized patients with diabetes and COVID-19, insulin treatment, as a possible proxy for diabetes duration, and obesity rather than long-term glycemic control were predictive of mortality. Further investigation of underlying mechanisms of mortality and inpatient glycemic control is needed.

Figure 1

Mortality by age (years), sex, and BMI in hospitalized patients with diabetes and COVID-19. P value compares all age-groups.