Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19

Author:

Seiglie Jacqueline12ORCID,Platt Jesse34,Cromer Sara Jane12ORCID,Bunda Bridget5,Foulkes Andrea S.6,Bassett Ingrid V.7,Hsu John89,Meigs James B.10,Leong Aaron1210,Putman Melissa S.1211,Triant Virginia A.7810,Wexler Deborah J.12,Manne-Goehler Jennifer7

Affiliation:

1. Diabetes Unit, Massachusetts General Hospital, Boston, MA

2. Department of Medicine, Harvard Medical School, Boston, MA

3. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA

4. Whitehead Institute for Biomedical Research, Cambridge, MA

5. Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA

6. Department of Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA

7. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA

8. Mongan Institute, Massachusetts General Hospital, Boston, MA

9. Department of Health Care Policy, Harvard Medical School, Boston, MA

10. Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

11. Boston Children’s Hospital, Boston, MA

Abstract

OBJECTIVE Diabetes and obesity are highly prevalent among hospitalized patients with coronavirus disease 2019 (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 11 March 2020 and 30 April 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. Among patients with diabetes versus patients without diabetes, a higher proportion was admitted to the ICU (42.1% vs. 29.8%, respectively, P = 0.007), required mechanical ventilation (37.1% vs. 23.2%, P = 0.001), and died (15.9% vs. 7.9%, P = 0.009). In multivariable logistic regression models, diabetes was associated with greater odds of ICU admission (odds ratio 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 greater 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 adjustment for obesity. These findings can help inform patient-centered care decision making for people with diabetes at risk for COVID-19.

Funder

MGH Division of Clinical Research

National Institute of Diabetes and Digestive and Kidney Diseases

National Heart, Lung, and Blood Institute

National Institute of Allergy and Infectious Diseases

National Institute of General Medical Sciences

National Institute on Aging

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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