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Diabetes mellitus as a risk factor for poor early outcomes in patients hospitalized with COVID-19

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posted on 31.08.2020 by Jacqueline Seiglie, Jesse Platt, Sara Jane Cromer, Bridget Bunda, Andrea S. Foulkes, Ingrid V. Bassett, John Hsu, James B. Meigs, Aaron Leong, Melissa S. Putman, Virginia A. Triant, Deborah J. Wexler, Jennifer Manne-Goehler
OBJECTIVE

Diabetes mellitus and obesity are highly prevalent among hospitalized patients with COVID-19, but little is known about their contributions to early COVID-19 outcomes. We tested the hypothesis that diabetes is a risk factor for poor early outcomes, after adjustment for obesity, among a cohort of patients hospitalized with COVID-19.

RESEARCH DESIGN AND METHODS We used data from the Massachusetts General Hospital (MGH) COVID-19 Data Registry of patients hospitalized with COVID-19 between March 11, 2020 and April 30, 2020. Primary outcomes were admission to the intensive care unit (ICU), need for mechanical ventilation, and death within 14 days of presentation to care. Logistic regression models were adjusted for demographic characteristics, obesity, and relevant comorbidities.

RESULTS

Among 450 patients, 178 (39.6%) had diabetes, mostly type 2 diabetes. A higher proportion of patients with diabetes were admitted to the ICU (42.1% vs. 29.8%, p=0.007), required mechanical ventilation (37.1% vs. 23.2%, p=0.001), and died (15.9% vs. 7.9%, p=0.009), compared with patients without diabetes. In multivariable logistic regression models, diabetes was associated with greater odds of ICU admission (OR 1.59 [95% CI 1.01-2.52]), mechanical ventilation (1.97 [1.21-3.20]), and death (2.02 [1.01-4.03]) at 14-days. Obesity was associated with higher odds of ICU admission (2.16 [1.20-3.88]) and mechanical ventilation (2.13 [1.14-4.00]) but not with death.

CONCLUSIONS

Among hospitalized patients with COVID-19, diabetes was associated with poor early outcomes, after adjusting for obesity. These findings can help inform patient-centered care decision making for people with diabetes at risk of COVID-19.

Funding

Support for the MGH COVID-19 Data Registry was provided by the MGH Division of Clinical Research. Jacqueline Seiglie and Sara Jane Cromer are supported by grant number T32DK007028 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Jesse Platt is supported by grant number 5T32DK007191-45 from the NIDDK. Virginia A. Triant is supported by NIH R01HL132786 and NIH R01AG062393. Jennifer Manne-Goehler is supported by grant number T32AI007433 from the National Institute of Allergy and Infectious Diseases. Ingrid Bassett is supported by K24AI141036. Andrea S. Foulkes is supported by NIH R01GM127862. John Hsu is supported by R01AG062282 and R01DK085070. The contents of this research are solely the responsibility of the authors.

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