Age, comorbidities, medication use among predictors for severe COVID-19 in diabetes
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Older age, obesity, cardiovascular disease, and pre-hospitalization use of steroids and SGLT2 inhibitors are among the factors that increase the risk for severe COVID-19 for people with diabetes, according to a speaker.
“Our study identified the diabetic subpopulation at risk of severe COVID-19 infection and can help clinicians risk stratify patients based on their risk factors in order to implement early intensive clinical care to reduce poor outcomes,” Samarth Virmani, MBBS, an internal medicine resident at the University of Central Florida HCA Healthcare GME in Orlando, told Healio.
Virmani and colleagues conducted a multicenter retrospective study of 1,818 people with diabetes who were hospitalized with COVID-19. Patients who were admitted to the ICU, died, or met clinical criteria indicating respiratory decompensation were defined as having severe COVID-19. Researchers collected data on demographics, BMI, HbA1c, diabetes complications, comorbidities and pre-hospitalization medication use. The findings were presented at the American Association of Clinical Endocrinology annual meeting.
People with diabetes were likely to have severe COVID-19 if they were older (OR = 1.01) or male (OR = 1.37). Those with a BMI of more than 35 kg/m2 (OR = 1.83), neuropathy (OR = 1.65) or cardiovascular disease (OR = 1.3) were also at an increased risk for COVID-19. The use of steroids (OR = 1.49) or SGLT2 inhibitors (OR = 1.85) prior to hospitalization increased the risk for severe COVID-19, whereas a lower risk for severe infection was observed among those taking ACE inhibitors (OR = 0.75) or statins (OR = 0.66).
“We were surprised to find out that pre-hospitalization use of steroids, which is now a common treatment option for hospitalized COVID-19 patients, could be detrimental and can increase the severity of COVID-19 in diabetics,” Virmani said.
People with diabetes and severe COVID-19 infection had a higher rate of hyperglycemia compared with those who had non-severe infection (44.35% vs. 37.6%). The proportion of patients with hypoglycemia was also higher among people with severe infection compared with those with non-severe infection (9.75% vs. 8.9%).
Virmani said the study’s findings can help providers identify people with diabetes who may be at the highest risk for severe COVID-19.
“Future prospective studies and clinical trials can reaffirm our study’s findings and establish whether early intensive clinical care in vulnerable diabetic patients can reduce poor outcomes,” Virmani said. “These studies can also increase our understanding of COVID-19’s effect on diabetic patients, which can eventually result in standardized clinical care of vulnerable diabetic patients.”
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Virmani S. Diabetes and COVID-19: Identifying diabetes-related predictors of severe infection. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).
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