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. 2022 Jan;5(1):e00309.
doi: 10.1002/edm2.309. Epub 2021 Dec 3.

The clinical profile and associated mortality in people with and without diabetes with Coronavirus disease 2019 on admission to acute hospital services

Krishna Gokhale  1   2   3 , Samiul A Mostafa  4   5 , Jingya Wang  1 , Abd A Tahrani  5   6   7 , Christopher Andrew Sainsbury  1 , Konstantinos A Toulis  1 , G Neil Thomas  1 , Zaki Hassan-Smith  5   8   9 , Elizabeth Sapey  1   3 , Suzy Gallier  3 , Nicola Jaime Adderley  1 , Parth Narendran  5   7 , Srikanth Bellary  6   10 , Tom Taverner  1 , Sandip Ghosh  4   5 , Krishnarajah Nirantharakumar  1   3   6 , Wasim Hanif  4   5
Affiliations

The clinical profile and associated mortality in people with and without diabetes with Coronavirus disease 2019 on admission to acute hospital services

Krishna Gokhale et al. Endocrinol Diabetes Metab. 2022 Jan.

Abstract

Introduction: To assess if in adults with COVID-19, whether those with diabetes and complications (DM+C) present with a more severe clinical profile and if that relates to increased mortality, compared to those with diabetes with no complications (DM-NC) and those without diabetes.

Methods: Service-level data was used from 996 adults with laboratory confirmed COVID-19 who presented to the Queen Elizabeth Hospital Birmingham, UK, from March to June 2020. All individuals were categorized into DM+C, DM-NC, and non-diabetes groups. Physiological and laboratory measurements in the first 5 days after admission were collated and compared among groups. Cox proportional hazards regression models were used to evaluate associations between diabetes status and the risk of mortality.

Results: Among the 996 individuals, 104 (10.4%) were DM+C, 295 (29.6%) DM-NC and 597 (59.9%) non-diabetes. There were 309 (31.0%) in-hospital deaths documented, 40 (4.0% of total cohort) were DM+C, 99 (9.9%) DM-NC and 170 (17.0%) non-diabetes. Individuals with DM+C were more likely to present with high anion gap/metabolic acidosis, features of renal impairment, and low albumin/lymphocyte count than those with DM-NC or those without diabetes. There was no significant difference in mortality rates among the groups: compared to individuals without diabetes, the adjusted HRs were 1.39 (95% CI 0.95-2.03, p = 0.093) and 1.18 (95% CI 0.90-1.54, p = 0.226) in DM+C and DM-C, respectively.

Conclusions: Those with COVID-19 and DM+C presented with a more severe clinical and biochemical profile, but this did not associate with increased mortality in this study.

Keywords: COVID-19; complications; diabetes.

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Conflict of interest statement

SAM has received research support from Novo Nordisk Research Foundation UK and Academy of medical Sciences. SB has received grants, personal fees, and support to attend educational meetings from Novo Nordisk; grants from The Binding Site; personal fees from AstraZeneca, Merck, Sharpe & Dohme, and Janssen; personal fees and support to attend educational meetings from Boehringer Ingelheim; personal fees and support to attend educational meetings from Eli Lilly; and personal fees and support to attend educational meetings from Sanofi‐Aventis and NAPP. WH has received Received Research Grants, Travel Grant and Consultancy for following AZ, BI, Eli Lilly, Jansen, Novo Nordisk, Sanofi, NAPP and MSD. Other authors have no declarations.

Figures

FIGURE 1
FIGURE 1
Measures of metabolic acidosis, I inflammation and immune response after hospital admission. Data presented for mean or median values over time. Key: HCO3, bicarbonate level; pCO2, partial pressure of carbon dioxide; K, potassium level; CRP, C‐reactive protein level; Na, sodium level; Ur, urea level; pO2, partial pressure of oxygen
FIGURE 2
FIGURE 2
Renal function, electrolytes, and physiological and laboratory measurements after hospital admission. Data presented for mean or median values over time. Key: HCO3, bicarbonate level; pCO2, partial pressure of carbon dioxide; K, potassium level; CRP, C‐reactive protein level; Na, sodium level; Ur, urea level; pO2, partial pressure of oxygen
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