COVID-19 and Diabetes Outcomes: Rationale for and Updates from the CORONADO Study

Abstract

Purpose of ReviewIn France, in order to describe the phenotypic characteristics of patients with diabetes hospitalized for coronavirus disease-2019 and to identify the prognostic factors in this specific population, the CORONADO (CORONAvirus and Diabetes Outcomes) study was launched. This review will summarize the key findings from the CORO-NADO study and put them in perspectives with others studies published on the subject. Recent Findings For almost 2 years, the new SARS-CoV-2 (Severe Acute Respiratory Syndrome-CoronaVirus-2), which causes COVID-19, has spread all around the world leading to a pandemic. From the first epidemiological reports, diabetes mellitus has rapidly emerged as a major risk factor associated with severe forms of COVID-19 but few data were available about diabetes characteristics in hospitalized people with COVID-19. Summary Between March 10 and April 10, 2020, 2951 patients were included in 68 centers throughout the national territory, including overseas territories. In the CORONADO study, the primary outcome was a composite endpoint combining invasive mechanical ventilation (IMV) and/or death within day 7 (D7). Secondary outcomes included death, IMV, intensive care unit (ICU) admission, and hospital discharge, all considered within D7 and day 28 (D28). The primary outcome occurred in 29.0% participants within D7 following hospital admission. Within D28, the end of the follow-up period, the mortality rate was 20.6%, while 50.2% of patients were discharged. In multivariable analysis, advanced age, microvascular complications, treatment with insulin or statin prior to admission, dyspnea on admission, as well as biological markers reflecting the severity of the infection (high levels of transaminases, leukocytes and CRP, and low platelet levels) were associated with an increased risk of death. Several exploratory analyses were performed to clarify the influence of some parameters such as weight status, sex, type of diabetes, and some routine drugs, including metformin or statins. KeywordsCOVID-19 • Diabetes • Outcomes • Prognosis • Risk factors • CORONADO study This article is part of the Topical Collection on Macrovascular Complications in Diabetes Drs S. Smati and B. Tramunt contributed equally to the work.

Diabetes and COVID-19: Short- and Long-Term Consequences

“…It reduces pulmonary inflammation and fibrosis in a rat model 45 , thereby prolonging survival and attenuating pulmonary injury. Clinical studies indicate that metformin users have a reduced probability to develop COVID-19 46 and a lower disease mortality 47 48 49 50 . DPP4 inhibitors (gliptins), in addition to their antidiabetic actions, have anti-inflammatory effects, reduce cytokine overproduction, and have been suggested as treatment of COVID-19 51 .…”

The impact of carbohydrate metabolism disorders on the early and long-term clinical outcomes of patients with COVID-19 according to the AKTIV and AKTIV 2 registries

“…Полученные данные, касающиеся уязвимости инфицированных SARS-CoV-2 пациентов с гипергликемией, соотносятся с результатами многочисленных отечественных и зарубежных исследований, в соответствии с которыми количество смертельных исходов среди лиц с СД также в 2–3 раза превышает таковое у лиц без СД. Так, во французском национальном исследовании CORONADO летальность пациентов с СД2 составила 20,6% [ 14 ], в США — 28,8% [ 15 ], в Великобритании — 30,1% [ 16 ], а по данным Федерального регистра сахарного диабета РФ — 15,2% [ 13 ].…”

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19

“…The CORONADO study demonstrated that admission glucose, compared to a reference value of 5.55 mmol/L, was associated with death and IMV. However, admission hyperglycemia was no longer associated with severity after adjustment for other laboratory covariates on admission [ 14 , 15 ]. A study from KSA found that neither blood glucose nor HbA1c affected the outcome in diabetic patients hospitalized with COVID-19 [ 33 ].…”

“…A study from China revealed that poorly controlled blood glucose during hospitalization correlated with higher mortality [ 13 ]. A French study showed that higher admission glucose levels, but not glycated hemoglobin (HbA1c) levels, were associated with higher rates of invasive mechanical ventilation (IMV) and death [ 14 , 15 ]. A population-based study from England found that higher HbA1c levels were associated with increased COVID-19 mortality [ 16 ].…”