Endocrine Abstracts

Introduction

Diabetes mellitus (DM) and older age are frequent comorbidities as well as factors associated with poorer outcomes in patients with Coronavirus disease (COVID-19). The reason for worse prognosis in patients with diabetes is likely to be multifactorial.

Objectives

We aimed to evaluate clinical characteristics and their impact on the outcomes of elderly patients with and without DM hospitalized with COVID-19.

Methods

In this retrospective study, we included 97 hospitalized patients (38 with DM, 59 without DM). We compared demographic characteristics, comorbidities, chronic medications, admission findings and outcomes between patients with and without DM.

Results

The mean age was 80 (± 9) and 75 (± 15) years in the group with DM and without DM, respectively. A higher prevalence of arterial hypertension (92.1% vs. 59.3%, P = 0.001), previous medication with RAAS inhibitors (64.9% vs. 44.1%, P = 0.047), chronic heart failure (55.3% vs. 32.2%, P = 0.024) and chronic pulmonary disease (28.9% vs. 11.9%, P = 0.035) was observed in patients with diabetes. There were no differences between groups regarding laboratorial and radiological findings at admission or fatality rate (36.8% DM vs 27.1% non-DM, P = 0.312). Among DM patients, nonsurvivors presented with higher Pneumonia Severity Index (PSI) score (159 ± 36 vs. 109 ± 30, P = 0.001), a higher NT-proBNP (5521 [4256–15280] vs. 1541 [288–2349] pg/ml, P = 0.047), a lower PaO2/FiO2 ratio (214 [181–259] vs. 300 [248–347], P = 0.033) and were more likely to have bilateral lung involvement at admission (78.6% vs. 29.2%, P = 0.013). Rates of acute kidney injury (85.7% vs. 33.3%, P = 0.003), acute heart failure (57.1% vs. 25.0%, P = 0.048) and secondary bacterial infection (64.3 vs. 26.1%, P = 0.022) were higher in deceased patients. When comparing deceased patients with survivors, there were no differences on the likelihood of being previously treated with insulin (60% vs 37.5%, P = 0.269), metformin (50% vs. 41%, P = 0.730), or DDP4i (40 vs. 33.3%, P = 0.775).

Conclusions

Elderly diabetic COVID-19 had a striking high risk of mortality. A more severe disease at presentation correlates with mortality. Organ disfunction reflects a rapid disease progression, significantly influencing the risk of death. These findings emphasize the frailty of diabetic and elderly patients with comorbidities, that should be regarded as high risk patients.