Type 2 diabetes common in patients with worsening COVID-19 progression in Japan
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More than 70% of patients admitted to a hospital in Japan with moderate COVID-19 whose condition worsened during hospitalization had dysglycemia, according to study findings.
“In our study, diabetes may constitute the largest risk factor in the accelerated progression of COVID-19 patients to the severe state,” Shizuka Kaneko, MD, PhD, director of the department of diabetes, endocrinology and metabolism at the Takatsuki Red Cross Hospital in Osaka, Japan, told Healio. “Additionally, the majority of deaths were elderly — the average age was 84.5 years. This figure is close to the average life expectancy in Japan. There were no deaths due to cardiovascular events. There was only one, nonfatal, victim with diabetes that experienced cerebral infarction. Obesity, lung disease and hemodialysis were not risk factors.”
Kaneko and colleagues conducted a retrospective analysis of patients admitted to Takatsuki Red Cross Hospital with COVID-19. COVID-19 patients in Osaka were stratified by disease severity into mild, moderate and severe categories. The analysis included 154 patients admitted with moderate COVID-19 from April 1, 2020, to March 31, 2021. Progression to severe classification, ventilation and advanced treatment, and mortality were outcomes in the study.
The findings were presented at the American Diabetes Association Scientific Sessions.
Of 154 people admitted with moderate COVID-19, 62 were moved to the severe classification and 48 required ventilation. Fourteen patients died of COVID-19 after ventilation was declined by their families; of these, nine had dysglycemia. One person with diabetes experienced a non-lethal cerebral infarction. There were no deaths due to cardiovascular events.
In multivariate logistic regression analysis, people with type 2 diabetes with an HbA1c of 6.2% or higher were more likely to move from moderate to severe COVID-19 than those with an HbA1c lower than 6.2% (OR = 6.142; 95% CI, 2.212-17.054; P < .001). Those older than 70 years also had a higher risk for severe COVID-19 (OR = 3.436; 95% Cim 1.123-10.515; P = .031), and men were more likely to move to severe COVID-19 compared with women (OR = 0.296; 95% CI, 0.106-0.826; P = .02). No association was observed between hypertension, BMI, lung disease, renal failure or insulin therapy with COVID-19 severity.
Kaneko said the findings highlight the importance of type 2 diabetes control and prevention.
“I believe that readers will be surprised that the effects of diabetes, which often remain hidden, can be so severe,” Kaneko said. “In light of the WHO information and the information gained from our study during this pandemic, there will hopefully be a global move to work on preventing diabetes in order to decrease the risk of contracting COVID-19 and future communicable diseases. In addition, I hope this illuminates the wider issues of diet, food nutrition and dietary health education for those whose work it is to foster health literacy.”
Kaneko said a more comprehensive, multicenter study covering all COVID-19 classifications from mild to severe is needed to confirm the findings.
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Kaneko S, et al. 1090-P. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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