Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study.

Aim: This study's objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).
Design: This was a cross-sectional study.
Settings: We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.
Outcome Measures: Multiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.
Results: Overall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.
Conclusion: The results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.
Competing Interests: Competing interests: EO has received advisory and or speaking fees from AstraZeneca, Boehringer Ingelheim, Lilly, MSD, Novo Nordisk, Sanofi and Amgen; he received research grants to the institution from MSD and Amgen. RC has received advisory and/or speaking fees from Abbott, Ascensia, Lilly, MSD, Novo Nordisk and Sanofi. MM-C has received advisory honorarium from AstraZeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received speaker honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, Menarini, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi. JF-N has received advisory and or speaking fees from AstraZeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. KK has acted as a consultant, speaker or received grants for investigator-initiated studies for AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Berlin-Chemie AG/Menarini Group, Janssen and Napp. DM has received advisory and/or speaking fees from AstraZeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. PD has received lecture and Advisory Board fees from Gilead Sciences, Roche, Merck, Sharp & Dohme, ViiV Healthcare, Janssen & Cilag, Theratechnologies, Boehringer Ingelheim and Ferrer International. PD has received research grants from Gilead Sciences, ViiV Healthcare, GSK, Janssen & Cilag and Boehringer Ingelheim. BV, FXCC, JR, RP-T, MG and EC have no conflict of interest to declare.
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