Diabetes mellitus may worsen COVID-19

Diabetes mellitus (DM) raises the risk of mortality and respiratory failure, as well as the need for intensive care, among patients with the coronavirus disease 2019 (COVID-19), reports a recent Philippine study.

The researchers conducted a subgroup analysis of the Philippine CORONA Study, comparing outcomes of 2,191 COVID-19 patients with DM (median age 61 years, 44.5 percent women) vs 8,690 patients without DM (median age 48 years, 47.47 percent women). Outcomes included mortality, respiratory failure, admission to the intensive care unit (ICU), and length of hospital stay.

A total of 1,702 deaths (15.6 percent) occurred during follow-up, with a significantly higher in-hospital mortality rate among DM patients (26.4 percent vs 12.9 percent; p<0.001). Multivariate logistic regression revealed that such event rates corresponded to an almost 50-percent higher likelihood of death among COVID-19 patients with vs without DM (adjusted odds ratio [OR], 1.46, 95 percent confidence interval [CI], 1.28–1.68; p<0.001).

Similarly, respiratory failure was significantly more likely to occur in the DM group (29.9 percent vs 10.9 percent; p<0.001; adjusted OR, 1.67, 95 percent CI, 1.46–1.90), as was ICU admission (33.7 percent vs 11.5 percent; adjusted OR, 1.80, 95 percent CI, 1.59–2.05).

Moreover, duration of ventilator dependence (median, 14 vs 12 days; p=0.002) and of hospital stay (median, 14 vs 13 days; p<0.001) were both significantly longer in COVID-19 patients with DM.

An important limitation of the study was its inclusion of hospitalized COVID-19 patients, which might have overestimated the effects of DM on respiratory failure and mortality, since only severe and critical patients tend to be hospitalized. The study was also unable to account for other confounders such as higher levels of medication use in diabetics, macrovascular and microvascular complications, and history of diabetic emergencies.

“Future studies focusing on the aforementioned parameters are needed to further establish the role and interaction between the presence of DM, DM complications, and the level of glycemic control on its effect on clinical outcomes among COVID-19 patients,” the researchers said.