Predictors of mortality in a multiracial urban cohort of persons with type 2 diabetes and novel coronavirus 19

• Published in: Journal of diabetes 2021-05, Vol.13 (5), p.430-438
• Main Authors: Myers, Alyson K., Kim, Tara S., Zhu, Xu, Liu, Yan, Qiu, Michael, Pekmezaris, Renee
• Format: Article
• Language: English
• Subjects: 2型糖尿病; Cardiovascular disease; Comorbidity; Coronaviruses; COVID‐19; Diabetes; glycemic control; Intubation; Mortality; Original; Severe acute respiratory syndrome coronavirus 2; Survival analysis; type 2 diabetes; urban population; 城市人口; 新冠肺炎; 死亡率; 血糖控制
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.13158

Background Diabetes has been identified as a risk factor for intubation and mortality in patients with coronavirus disease 2019 (COVID‐19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We seek to examine the impact of clinical variables such as glycosylated hemoglobin (HbA1c) on mortality and need for intubation, as well as demographic variables such as age, sex, and race on persons with type 2 diabetes and COVID‐19. Methods Analyses were conducted on 4413 patients with an International Classification of Diseases and Related Health Problems (ICD‐10) diagnosis of type 2 diabetes and COVID‐19. Survival analysis was conducted using Kaplan‐Meier curves and the log‐rank test to compare subgroup analyses. Results In this multivariate analysis, male gender, older age, and hyperglycemia at admission were associated with increased mortality and intubation, but this was not seen for race, ethnicity, insurance type, or HbA1c. Based on Kaplan‐Meier analysis, having comorbid conditions such as hypertension, chronic kidney disease, and coronary artery disease was associated with a statistically significant increased risk of mortality. Conclusions Glycemic levels at admission have a greater impact on health outcomes than HbA1c. Older men and those with comorbid disease are also at greater risk for mortality. Further longitudinal studies need to be done to evaluate the impact of COVID‐19 on type 2 diabetes. 摘要 背景 糖尿病已被确定为由新型严重急性呼吸综合征冠状病毒2型(SARS‐CoV‐2)引起的2019年新型冠状病毒肺炎患者气管插管和死亡的危险因素。我们试图检查临床变量如糖化血红蛋白(HbA1c)对死亡率和插管需求的影响, 以及人口统计学变量如年龄、性别和种族对2型糖尿病和新型冠状病毒肺炎患者的影响。 方法 对4413例符合国际疾病和相关健康问题的分类(ICD‐10)分类诊断为2型糖尿病和新型冠状病毒肺炎的患者进行分析。生存分析采用Kaplan‐Meier曲线和对数秩检验进行亚组分析比较。 结果 在这项多变量分析中, 男性、高龄和入院时高血糖与死亡率和气管插管增加相关, 但与种族、民族、保险类型或糖化血红蛋白无关。根据Kaplan‐Meier分析, 患有高血压、慢性肾脏疾病和冠心病等并存疾病与死亡风险在统计学上显著增加相关。 结论 入院时的血糖水平比糖化血红蛋白对健康结局的影响更大。老年男性和合并疾病的患者死亡风险也更大。需要做进一步的纵向研究来评估新型冠状病毒肺炎对2型糖尿病的影响。 Highlights Admission serum or point‐of‐care glucose is a greater predictor of mortality than glycosylated hemoglobin in persons with type 2 diabetes and coronavirus disease 2019 (COVID‐19). Those with diabetes and COVID‐19 who were intubated had a higher morality than those who were not intubated. Older age, male gender, and history of chronic kidney disease, hypertension, or coronary artery disease increased the risk of mortality. Race and insurance type had no impact on mortality.