Pneumonia, uncontrolled inflammation more common in COVID-19 with diabetes
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A cohort of Chinese adults with diabetes but without other comorbidities were more likely to develop inflammatory storm leading to rapid deterioration in COVID-19 compared with adults without diabetes who contracted the novel coronavirus, study data from Wuhan show.
“Common perceptions associate diabetes with a generally increased mortality and morbidity to infectious diseases, although epidemiologic data that would prove this are surprisingly scarce,” Desheng Hu, MD, a professor in the department of integrated traditional Chinese and western medicine at Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China, and colleagues wrote. “However, it seems to be confirmed that diabetes predisposes to certain types of infection and death, but it is still unknown whether diabetes is a risk factor for the prognosis of COVID-19.”
In a retrospective study, Hu and colleagues analyzed data from 174 consecutive patients with confirmed COVID-19 admitted to Wuhan Union Hospital between Feb. 10 and Feb. 29, including medical history, symptoms, laboratory findings, chest CT and treatment measures (mean age, 59 years; 43.7% men).
“We divided all patients into two groups based on whether they had diabetes,” the researchers wrote. “In the second part, we excluded patients with comorbidities other than diabetes to avoid the impact of other comorbidities, and then the patients with diabetes and patients without diabetes were separated into two groups.”
Within the cohort, the most common symptoms were fever (78.2%), chill (68.4%), cough (32.2%), fatigue (27%), chest tightness (25.9%), shortness of breath (24.1%) and myalgia (20.7%). More rare were symptoms of nausea (9.8%), headache (6.9%), pharyngalgia (5.2%) and chest pain (8.6%). The most common comorbidities were hypertension (24.7%) and diabetes (21.2%).
Researchers found that patients with COVID-19 and diabetes, but no other comorbidities (n = 24), were at higher risk for severe pneumonia, release of tissue injury-related enzymes, excessive uncontrolled inflammation responses and hypercoagulable state associated with dysregulation of glucose metabolism when compared with patients without diabetes.
Additionally, CT chest images from patients with COVID-19 and diabetes showed more severe pathological changes vs. those with COVID-19 but no diabetes.
“We found that the diabetes group presented higher CT imaging score[s] compared with [the] non-diabetes group,” the researchers wrote.
Levels for inflammation-related biomarkers, such as interleukin-6, C-reactive protein, serum ferritin and coagulation index, and D-dimer were higher (P < .01) in patients with COVID-19 and diabetes compared with those without diabetes, suggesting that patients with diabetes are more susceptible to an inflammatory storm eventually leading to rapid deterioration of COVID-19. Similarly, levels of total protein, albumin, absolute counts of lymphocytes and red blood cells and hemoglobin were all lower among patients with COVID-19 and diabetes vs. those without diabetes.
“All in all, whether interference from other comorbidities is present or not, we found that SARS-CoV-2 pneumonia patients with diabetes are more severe than those without diabetes evaluating from organ damage, inflammatory factors or hypercoagulability, and are more likely to progress into a worse prognosis,” the researchers wrote. “Therefore, diabetes might be considered as a risk factor for the outcome of SARS-CoV-2 pneumonia, and more intensive attention should be paid to patients with diabetes, in case of rapid deterioration.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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David C. Lieb, MD, FACE, FACP
The data provided in this study by Guo and colleagues at Union Hospital comes at a critical time. Union Hospital is located in Wuhan, the capital city of the Chinese province Hubei, where the novel coronavirus SARS-CoV-2 outbreak was first identified in December 2019. Any published information regarding diabetes and COVID-19 is much appreciated, as the landscape is changing rapidly, and we need all the information available to properly care for our patients.
The authors found that individuals with diabetes and COVID-19 were more likely to present with advanced findings on chest CT compared with those without diabetes, and that individuals with diabetes but no other comorbid conditions demonstrated a significant inflammatory, hypercoagulable state compared with COVID-19 patients without diabetes. This is especially important as patients with diabetes may require more aggressive therapies that include anti-coagulation, and new focused anti-inflammatory therapies are currently being tested, including IL-6 receptor inhibitors. It would have been helpful for the authors to define the comorbid conditions they included in their study. It also would be helpful to know more about the patients with diabetes — duration of diabetes, BMI, type 1 vs type 2 diabetes and glycemic control such as their HbA1c. It would also be important to know whether these patients were taking angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers, given some concerns that these agents may increase risk for infection with SARS-CoV-2.
In summary, this study provides much needed data regarding the experience of patients with diabetes in Wuhan. The authors should be commended for analyzing and providing their much-needed experience so quickly.
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