Diabetes may worsen outcomes in COVID-19
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Adults with diabetes are no more likely to contract COVID-19 than people without diabetes, but could be up to twice as likely to die from complications of the disease, according to an analysis of data from China and Italy published in the Journal of Endocrinological Investigation.
“Diabetes does not increase the risk of new coronavirus infection, but it can worsen the outcome of COVID-19,” Gian P. Fadini, MD, PhD, associate professor of endocrinology at the University of Padova, Italy, told Healio. “People with diabetes can be reassured they are not at higher risk for becoming infected, but they have to pay additional attention to symptoms and signs of disease progression.”
Research suggests that diabetes is one of the most common comorbidities among people infected with COVID-19; however, its exact prevalence is unclear, Fadini and colleagues wrote in a letter to the editor. In a meta-analysis, Fadini and colleagues analyzed data from 12 studies reporting the prevalence of diabetes among Chinese adults infected with COVID-19 and its impact on disease severity or progression (n = 2,108; mean age, 50 years). Across studies, the prevalence of diabetes was 10.3%.
“For comparison, the nationwide prevalence of diabetes in China in 2013 was 10.9% overall and 12.3% among people aged 40 to 59 years,” the researchers wrote.
Italy was the second country most affected with COVID-19 as of March 19, with 41,035 individuals with confirmed coronavirus cases. Of the 146 hospitalized adults with COVID-19 at the University Hospital of Padova, located at the center of the Italian outbreak, 13 had preexisting diabetes (mean age, 65 years), for a prevalence of 8.9% (95% CI, 5.3-14.6).
“For comparison, the prevalence of diabetes in the same region in 2018 was 6.2% overall and 11% among people aged 55 to 75 years,” the researchers wrote. “A relatively low prevalence of diabetes among SARS-CoV-2 infected people could be due to underreporting, chance or a biological phenomenon.”
Six of the studies analyzing Chinese patients reported the prevalence of diabetes according to disease severity or outcome (n = 1,687). Compared with adults who had a more favorable coronavirus disease course, the pooled rate ratio of diabetes among patients with an adverse coronavirus disease course was 2.26 (95% CI, 1.47-3.49).
As of March 17, the median age of 2,003 Italian patients who died while infected with COVID-19 was 81 years (70% men). Among 355 Italian patients with COVID-10 who died and had available information on comorbidities, diabetes prevalence was 35.5%.
“In 2018, diabetes prevalence among Italian citizens with the same age range and sex distribution was 20.3%,” the researchers wrote. “Thus, the rate ratio of diabetes among patients who died with SARS-CoV-2 infection compared to the general population was 1.75. Based on these data, we conclude that diabetes may not increase the risk of SARS-CoV-2 infection, but can worsen the outcome of this new coronavirus disease.”
The researchers wrote that the finding is consistent with the association between diabetes and excess mortality from any acute and chronic condition, including infections.
“We are exploring if some diabetes therapies, such as DPP-IV inhibitors, could be better than others in preventing infection and/or disease progression,” Fadini said. – by Regina Schaffer
For more information:
Gian P. Fadini, MD, PhD, can be reached at the Department of Medicine, University of Padova, Venetian Institute of Molecular Medicine, Via Giustiniani 2, 35128, Padua, Italy; email: gianpaolo.fadini@unipd.it.
Disclosure: Fadini reports no relevant financial disclosures.
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