Editor’s note: Discover the latest COVID-19 news and instructions in the Medscape Coronavirus Resource Center.
While half of diabetic patients in hospital with COVID-19 will be discharged from hospital within a month of admission, a fifth will have died, recommend the latest results from the French CORONADO study.
The study, started in the first wave of pandemic, has already collected a lot of data, with early findings published in May 2020 recommending 10.6% of patients with type 2 diabetes 2 and COVID-19 and 5.6% of those with type 1 diabetes and died of COVID-19 within 7 days of admission to hospital.
The current results at 28 days were presented at a press conference held by the Francophone Foundation for Diabetes Research (FFRD) on February 3, and were just published in Diabetologia.
Identifying Patient Phenotype
For the study, 2796 diabetic patients were hospitalized with COVID-19 at 68 institutions across France between 10 March and 10 April 2020, and were followed for 28 days.
The data analysis was performed on the basis of “patient phenotype.”
“We compiled all relevant medical information: history, routine treatment, clinical and biological presentation, and hospital prognosis,” says lead author Matthieu Wargny, MD, L’Institut du Thorax, INSERM, CNRS, Nantes University Hospital , France.
The main outcome was tracheal intubation and / or death.
“We were also interested in positive outcomes, such as returning home or a care home, moving to another hospital, or follow-up care,” Wargny notes.
20% mortality rate
Of the participants, 63.7% were male, the average age was 69.7 years, and a body size index was 28.4 kg / m2. In addition, 44.2% of patients had microvascular problems with 38.6% and 38.6%.
After 28 days, 577 patients (20.6%) had died and 1404 (50.2%) had been discharged. The median time in hospital was 9 days.
“We also found that 12.2% of patients were still in the hospital and 16.9% were evacuated,” says Wargny, who confirms that the data were collected during the first wave of the pandemic and that would certainly be different today, with hospital mortality declining among patients with COVID-19.
He added that the researchers were able to “identify the main prognostic risk factors, both negative and positive.”
Among the risk factors that worked poorly, age of promotion was the most important. This was followed by a history of microbiological complications, particularly kidney and eye damage, dyspnea at admission, and inflammatory symptoms (white blood cell count, elevated C-reactive protein, and elevated aspartate transaminase).
Among the positive risk factors, researchers identified standard treatment with metformin and a history of COVID-19 symptoms before hospitalization.
On the other hand, blood glucose level was a neutral prognostic factor, a result that Wargny describes as “unexpected.”
Another neutral factor was treatment with DPP-4 inhibitors. Statin therapy was a negative prognostic factor, with a 42% increased risk of death among patients on statins for whom complete data were available.
However, “these are post-hoc studies that are unable to answer questions about the treatment of diabetic patients in hospital with COVID,” warns Wargny. In other words, it is not possible to draw conclusions on the effect of one treatment over another.
Subject to publication, other work with the team will focus on gender-based prognostic differences, degree of microangiopathic impairment, and the impact of bariatric surgery.
“We have encouraging data for patients who have undergone bypass surgery or narrow gastrectomy,” notes Wargny.
Overall risk of death from COVID-19 Low Residue in those with diabetes
In a statement, Faye Riley, chief research communications officer at Diabetes UK, said: “This study supports previous research which has shown that there are some risk factors, such as old age and a history of disease complications diabetes, putting people with diabetes at a higher risk of harm if they catch a coronavirus. It also gives us a new perspective on factors involved in getting past the virus faster.
“Understanding which people with diabetes are at higher risk if admitted to hospital with coronavirus will help improve care and save lives. But it’s also important to remember that the overall risk of death for people with diabetes remains low and has decreased last year. “
“Since the data in the study was captured, our understanding of how to treat coronavirus has grown, and new drugs that have been shown to reduce the risk of death are now in regular use,” she said.
The study received funding from the FFRD, supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly; Fédération Française des Diabétiques; Société Francophone du Diabète; and Fonds de dotation du CHU de Nantes. (CORONADO Project: Sanofi, Air Liquid Healthcare, Novo Nordisk, NHC, Allergan, LifeScan.) Wargny has reported relationships with Novo Nordisk.
Diabetologia. Published online February 18, 2021. Summary
For more diabetes and endocrinology news, let’s move on Twitter and Facebook.