Endocrine Abstracts

Background and Aims: Diabetes is often associated with an increased severity and mortality in COVID-19 patients. Possible mechanisms include hyperglycemia-induced impaired immune response, characterized by a state of chronic low-grade inflammation. Objectives: evaluate if diabetes and glycemic control were related to the severity of disease and mortality in hospitalized COVID-19 patients.

Methods: We conducted a retrospective case control study that included 224 patients hospitalized with COVID-19 in our center between March 2020 and February 2021. We randomly selected 112 diabetic patients in the study group and 112 non-diabetic patients in the control group. Primary endpoints were admission to the intensive care unit(ICU), need for mechanical invasive ventilation(MIV) and in-hospital death.

Results: We evaluated 224 patients, 50.4% female, with a mean age 72.1 years. Among patients with diabetes, 93.8% were type 2 and 6.2% were type 1. In-hospital death occurred in 18.3%. A higher proportion of diabetic patients (vs patients without diabetes) was admitted to the ICU (24% vs 17%, respectively, P=0.355), required MIV (37.1% vs 23.2%, P=0.105), and died (15.9% vs 7.9%, P=0.226). A subgroup analysis within diabetic patients, showed that patients with poor primary outcomes had higher HbA1c levels, namely ICU admission (8.3% vs 7.6%, P=0.03), MIV (8.6% vs 7.6%, P=0.02) and death (8.9 vs 7.6%, P=0.001). Considering the primary outcomes, older age (P=0.001) and hypertension (P=0.02) were associated with death, and obesity was associated with MIV (P=0.008). In multivariable analysis, HbA1c was an independent prognostic factor of mortality (OR 1.6, 95% CI:1.2-2.3, P=0.003), ICU admission (OR 1.3, 95% CI:1.1-1.7, P=0.04) and MIV (OR 1.4, 95% CI:1.1-1.9, P=0.02) in diabetic patients.

Conclusions: In this study, higher HbA1c in diabetic COVID-19 patients were associated with worse outcomes. Advancing age, hypertension and obesity were also found to be important predictors of poor outcome in COVID-19 patients.