One-fifth of COVID-19 sufferers with diabetes die inside 28 days of hospitalization

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February 18, 2021

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Disclosure:
Cariou reports he has received grants and personal fees from Amgen, AstraZeneca, Akcea, Genfit, Gilead, Eli Lilly, Novo Nordisk, MSD, Sanofi and Regeneron. Hadjadj reports that he has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, MSD, Novartis, Sanofi, Servier and Valbiotis; Grants from Bayer, Dinno Santé and Pierre Fabre Santé; and non-financial support from AstraZeneca, LVL, MSD, Sanofi and Servier. In the study you will find all relevant financial information from all other authors.

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New data from the CORONADO study shows that 20% of diabetics admitted to hospital with COVID-19 die within 28 days of admission, while half are discharged within the same amount of time.

“CORONADO is the first registered study specifically aimed at describing phenotypic characteristics and identifying prognostic factors in patients with diabetes who were hospitalized for COVID-19.” Samy Hadjadj, MD, PhD, Professor of Endocrinology and Diabetes at L’institut du Thorax and Nantes University Hospital and Deputy Head of the Department of Endocrinology, Diabetes and Nutrition at the University of Nantes in France; Bertrand Cariou, MD, PhD, Professor of Endocrinology at the Nantes University Hospital; and colleagues wrote in a study published in Diabetologia. “The present analysis reports the results of the full CORONADO study with a total of 2,796 participants from 68 centers with full follow-up by day 28.”

About half of those hospitalized with COVID-19 with diabetes were discharged within 28 days of admission, while about 20% died within the same amount of time.

The researchers analyzed data from 2,796 people with diabetes who were hospitalized with COVID-19 (63.7% men; mean age 69.7 years) in 68 hospitals in France between March 10 and April 10. Pre-admission, clinical, radiological, and biological features data on admission characteristics were analyzed post-admission. The updated analysis was performed on the patients on day 28 to determine mortality and hospital discharge results.

28 days after hospitalization, 50.2% of the study population was discharged, while 20.6% of the study population died, 16.9% were transferred to another facility, and 12.2% remained in the hospital.

Older adults and those with a history of hypertension, microvascular or macrovascular diabetes complications, heart failure, and chronic obstructive pulmonary disease (COPD) were less likely to be discharged after 28 days. Those taking metformin or DPP-IV inhibitors were more likely to be discharged, while insulin, diuretics, beta-blockers, and anticoagulation therapy were associated with a lower chance of being discharged. Dyspnoea, plasma creatinine, and almost all biological findings associated with an inflammatory profile were associated with a lower likelihood of discharge. Predictors of discharge within 28 days of admission were younger age, metformin therapy, and the longer time between onset of symptoms and hospital admission.

HbA1c history or at admission was not associated with results after 28 days.

In the age-adjusted analysis, men, those with longer duration of diabetes, and those with a history of microvascular or macrovascular complications, heart failure, and COPD were more likely to die of COVID-19 within 28 days of admission. People with a fever or shortness of breath on admission had a higher chance of 28-day mortality, and almost all biological covariates that reflect the severity of COVID-19 were also associated with death. In multivariate models, higher age, history of microvascular complications, routine insulin and statin medication, difficulty breathing on admission, higher aspartate aminotransferase, higher white blood cell counts, lower platelet count, and higher C-reactive protein with a associated increased risk of death. Metformin therapy and a longer time between onset of symptoms and admission were associated with a lower probability of mortality.

“Identifying favorable variables related to hospital discharge and unfavorable variables related to death can reclassify the patient and help appropriately use resources according to individual patient profiles,” the researchers write.

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