Association of COVID-19 outcomes with diabetes in the Veneto region (north-east italy): Epidemiological insights for the endemic phase?

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2023-11, Vol.33 (11), p.2141-2150
• Main Authors: Piarulli, Francesco, Carollo, Massimo, Ragazzi, Eugenio, Benacchio, Luca, Piovanello, Fabio, Simoncello, Ivana, Lapolla, Annunziata
• Format: Article
• Language: English
• Subjects: COVID-19; Diabetes; Hypertension; Metabolic control; RAAS-i
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2023.06.016

Diabetes mellitus is a prevalent chronic disease in patients who die of COVID-19. The aim of this study was to investigate the clinical and metabolic characteristics of diabetic patients with COVID-19 during the pre-vaccination phase. A retrospective cohort study was conducted from February 2020 to February 2021 to examine the clinical and metabolic profiles of unvaccinated diabetic patients affected by COVID-19. Data were collected from claim databases, hospital discharge records, and clinical records within a healthcare district located in northeastern Italy with a population of 936,000. Potential prognostic indicators including sex, age, Body Mass Index (BMI), duration and type of diabetes, metabolic control, and the use of antidiabetic, antihypertensive, lipid-lowering, and antiplatelet therapies were investigated. For hospitalized patients, additional variables were recorded, such as length of hospital stay, blood pressure at admission, comorbidities, D-dimer levels, blood glucose (BG), in-hospital insulin and corticosteroid therapies, requirement for mechanical ventilation (i.e., orotracheal or tracheostomy), admission to the Intensive Care Unit (ICU), and mortality. Diabetic patients hospitalized for COVID-19 with a poorer prognosis were characterized by advanced age, longer diabetes duration, hypertension, higher usage of sulfonylureas, and lower usage of dietotherapy alone, metformin, Glucagon-Like Peptide-1 Receptor agonists (GLP1-Ra), and Renin-Angiotensin-Aldosterone System inhibitors (RAAS-i). Considering the potential for COVID-19 to become endemic, special care should be taken in managing older diabetic patients’ treatments. •Use of RAAS-i prior to COVID-19 was found to be associated with the best outcomes.•Dietotherapy alone, metformin, and GLP1-Ra were related to fewer hospitalizations.•Use of sulfonylureas and in-hospital corticosteroids were related to poor prognosis.•The COVID-19 endemic phase demands cautious therapy for older diabetic patients.