Impact of Comorbidities, Glycemia at Admission and DPP4 Inhibitors in Type 2 Diabetic Patients with COVID-19: a Case Series from an Academic Hospital in Lombardy, Italy
Diabetes mellitus may unfavorably influence the outcome of Coronavirus disease-19 (COVID-19), but the determinants of this effect are still poorly understood.
In this monocentric study we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels and antidiabetic medications on the survival of COVID-19 patients.
RESEARCH DESIGN AND METHODS
This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) pandemic in Italy, between February 20 and April 9, 2020.
Medical history, pharmacological treatments, laboratory findings and clinical outcomes of non-diabetic and type 2 diabetic patients were compared. Cox proportional hazards analysis was applied to investigate risk factors associate with mortality.
Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of non-diabetic subjects (42.3% vs 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension [adjusted hazard ratio (aHR) 1.84, 95% confidence interval (C.I.) 1.15-2.95; P = 0.011), coronary artery disease (aHR 1.56, 95% C.I. 1.04-2.35; P = 0.031), chronic kidney disease (aHR 2.07, 95% C.I. 1.27-3.38; P = 0.003), stroke (aHR 2.09, 95% C.I. 1.23-3.55; P=0.006) and cancer (aHR 1.57, 95% C.I. 1.08-2.42; P = 0.04), but not with type 2 diabetes (P = 0.170).
In diabetic patients, elevated plasma glucose (aHR 1.22, 95% C.I. 1.04 – 1.44 per mmol/l; P = 0.015) and IL-6 levels at admission [aHR 2.47, 95% C.I. 1.28 – 4.78 per 1 standard deviation (SD) increase, P = 0.007] as well as treatments with insulin (aHR 3.05, 95% C.I. 1.57-5.95; P = 0.001) and beta-blockers (aHR 3.20, 95% C.I. 1.50-6.60; P = 0.001) were independently associated with an increased mortality, whereas the use of DPP-4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% C.I. 0.02 – 0.92, P = 0.042).
Plasma glucose levels at admission and antidiabetic drugs may influence the survival of COVID-19 patients affected by type-2 diabetes.