Clinical Characteristics of COVID-19 Patients in a Regional Population With Diabetes Mellitus: The ACCREDIT Study

Abstract

ObjectiveTo identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19.Research Design and MethodsWe conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1 January to 30 June 2020. We also explored the impact on inpatient diabetes team resources. Univariate and multivariate logistic regression analyses were performed and optimised by splitting the dataset into a training, test, and validation sets, developing a robust predictive model for the primary outcome.ResultsWe analyzed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% belonged to the most deprived population quintile in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. The primary outcome (7-day mortality) occurred in 24%, increasing to 33% by day 30. Approximately one in ten patients required insulin infusion (9.8%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality [p < 0.05, OR 2.52 (1.06, 5.98)]. Patients requiring insulin infusion had a lower risk of death [p = 0.02, OR 0.5 (0.28, 0.9)]. CKD in younger patients (<70 years) had a greater risk of death [OR 2.74 (1.31-5.76)]. BMI, microvascular and macrovascular complications, HbA1c, and random non-fasting blood glucose on admission were not associated with mortality. On multivariate analysis, CRP and age remained associated with the primary outcome [OR 3.44 (2.17, 5.44)] allowing for a validated predictive model for death by day 7.ConclusionsHigher CRP and advanced age were associated with and predictive of death by day 7. However, BMI, presence of diabetes complications, and glycaemic control were not. A high proportion of these patients required insulin infusion warranting increased input from the inpatient diabetes teams.

The impact of type 2 diabetes and glycaemic control on mortality and clinical outcomes in hospitalized patients with COVID‐19 in the capital region of Denmark

“…Previous studies have found varying associations between HbA1c and COVID‐19‐related outcomes 3,18,21,23,24 . A large English study in primary care described a clear association between higher HbA1c in patients and COVID‐19‐related death, 3 but several other studies, including the present, have not been able to reproduce these findings 18,21,23,24 .…”

The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

“…The CORONADO study found that both microvascular (OR 2.14 [95% CI:1.16–3.94]) and macrovascular (OR 2.54 [95% CI: 1.44–4.50]) complications were independently associated with the risk of death on day seven of admission after adjusting for age, sex, comorbidities/complications, and glucose-lowering and anti-hypertensive treatment [ 13 , 14 , 19 ]. By contrast, no association was found between mortality (death by day seven of admission) and micro- or macrovascular complications in the ACCREDIT Study [ 15 ]. Nevertheless, both cohorts differ in several aspects such as mean age (69.8 in the CORONADO study vs. 74.1 for the ACCREDIT study cohort), median BMI (28.4 kg/m 2 vs. 27.6 kg/m 2 ), the mean HbA1c (8.1% vs. 7.7%), which may partially explain the different results regarding the outcomes [ 13 – 15 , 19 ].…”

“…By contrast, no association was found between mortality (death by day seven of admission) and micro- or macrovascular complications in the ACCREDIT Study [ 15 ]. Nevertheless, both cohorts differ in several aspects such as mean age (69.8 in the CORONADO study vs. 74.1 for the ACCREDIT study cohort), median BMI (28.4 kg/m 2 vs. 27.6 kg/m 2 ), the mean HbA1c (8.1% vs. 7.7%), which may partially explain the different results regarding the outcomes [ 13 – 15 , 19 ]. Our analysis suggests that participants living with diabetes hospitalized for COVID-19 with previous macrovascular complications (ischemic heart disease, stroke, peripheral artery disease) have an approximately 50% higher risk of mortality compared to people with no history of macrovascular disease after adjusting for all available confounding factors and that ischemic heart disease and stroke are the main contributors to this higher risk.…”

“…Therefore, identifying which clinical factors are associated with greater morbidity and mortality would be useful for the prevention and management of high-risk groups during future waves of the pandemic. In that sense, few studies have examined the possibility that micro- and macrovascular complications contribute to susceptibility to acute organ injury [ 13 , 14 ] but with contradictory results [ 15 ].…”

Overview of the cardio-metabolic impact of the COVID-19 pandemic

“…On the other hand, in ACCREDIT study, BMI, presence of DM complications, and glycemic control were not associated with mortality. However, higher CRP levels and advanced age were still predictive of 7-day mortality [62]. In a meta-analysis of laboratory predictors of poor outcome in diabetic COVID-19 patients, having higher levels of the inflammatory parameters, increased coagulation and cardiac activity markers, and lower lymphocyte count were associated with poor outcome [63].…”