The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID‐19

• Published in: Journal of Diabetes 2020-12, Vol.12 (12), p.909-918
• Main Authors: Xu, Zihui, Wang, Zhongjing, Wang, Shuo, Ye, Yingchun, Luo, Deng, Wan, Li, Yu, Ailin, Sun, Lifang, Tesfaye, Solomon, Meng, Qingtao, Gao, Ling
• Format: Article
• Language: English
• Subjects: 2019冠状病毒病; 2型糖尿病; Aged; antihyperglycemic drugs; Biomarkers - analysis; Blood Glucose - analysis; China - epidemiology; Clinical outcomes; clinical status; coronavirus disease 2019 (COVID‐19); COVID-19; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - transmission; COVID-19 - virology; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - virology; Disease management; Drug therapy; Female; Follow-Up Studies; glucocorticoid; Glucocorticoids - therapeutic use; Glucose; Humans; Hyperglycemia; Hypoglycemic Agents - therapeutic use; Inflammation; Male; Medical prognosis; Middle Aged; Original; Prognosis; Risk factors; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Survival Rate; type 2 diabetes; 临床状况; 糖皮质激素; 降糖药
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.13084

Background Although type 2 diabetes mellitus (T2DM) patients with coronavirus disease 2019 (COVID‐19) develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with antihyperglycemic drugs and glucocorticoids is unclear. Methods From 1584 COVID‐19 patients, 364 severe/critical COVID‐19 patients with clinical outcome were enrolled for the final analysis, and patients without preexisting T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes. Results Of 364 enrolled severe COVID‐19 inpatients, 114 (31.3%) had a history of T2DM. Twenty‐seven (23.7%) T2DM patients died, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury compared with non‐DM patients. In severe COVID‐19 patients with T2DM, we demonstrated a higher risk of all‐cause fatality with glucocorticoid treatment (adjusted hazard ratio [HR], 3.61; 95% CI, 1.14‐11.46; P = .029) and severe hyperglycemia (fasting plasma glucose ≥11.1 mmol/L; adjusted HR, 11.86; 95% CI, 1.21‐116.44; P = .034). Conclusions T2DM status aggravated the clinical condition of COVID‐19 patients and increased their critical illness risk. Poor fasting blood glucose (≥ 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID‐19. 摘要 背景 虽然2019冠状病毒病(COVID‐19)合并2型糖尿病(T2DM)患者比未患糖尿病的患者病情更加严重, 但其发病机制尚不清楚。此外, 降糖药和糖皮质激素治疗对COVID‐19的影响尚不清楚。 方法 对我院1584例COVID‐19住院患者的临床资料进行回顾性分析。我们排除了既往无T2DM但血糖升高的患者, 得到364例重型/危重型COVID‐19患者作为最终分析对象, 收集其流行病学资料和临床转归, 以评估T2DM及其治疗对COVID‐19临床预后的影响。 结果 在364例重型/危重型COVID‐19住院患者中, 114例(31.3%)有T2DM病史。27例(23.7%)T2DM患者死亡, 这些患者比非糖尿病患者具有更严重的炎症反应、凝血激活、心肌损伤、肝损伤和肾损伤。在T2DM合并COVID‐19重症患者中, 糖皮质激素治疗(校正HR, 3.61；95%CI, 1.14‐11.46；P=0.029)和严重高血糖(空腹血糖≥11.1 mmol/L；校正HR, 11.86；95%CI, 1.21‐116.44；P=0.034)的全因死亡风险更高。 结论 T2DM加重COVID‐19病情并增加其危重症风险。空腹血糖不良(≥11.1mmol/L)和糖皮质激素治疗与重症COVID‐19患者预后不良相关。 Highlights Type 2 diabetes mellitus (T2DM) patients with severe acute respiratory syndrome coronavirus 2 infection had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury. T2DM aggravated the clinical status of coronavirus disease 2019 (COVID‐19) patients and increased their critical illness rate and mortality. Glucocorticoid treatment and poor fasting blood glucose (≥11.1 mmol/