Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Abstract

Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

Risk factors for COVID-19 hospitalisation and death in people living with diabetes: A virtual cohort study from the Western Cape Province, South Africa

“… [15] Updated results from the French CORONADO Study of 2796 PLWD (mean age 69·7) who were hospitalised reported a mortality rate of 11·2% within 7 days, which continued to increase to 20·6% by 28 days. [16] We can only speculate about factors that account for such a high mortality in our setting, even in relatively young patients, which includes social determinants such as poor access to care, general poor standards of chronic care for diabetes such as glycaemic control and management of complications, higher threshold for admission and reduced access to ICU beds once admitted. [17] The high background of infectious diseases in the population may also contribute to mortality.…”

Managing diabetes in diabetic patients with COVID: where do we start from?

“…A similar result was reported by Izzi-Engbeaya for deaths within 30 days (OR 0.66; 95% CI, 0.30–1.52) in univariate analysis [ 24 ] and by Silverii and colleagues [ 25 ]. The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study also found a neutral effect of SUs/glinides on mortality (OR 0.83; 95% CI, 0.67–1.03) within 28 days [ 26 ]. In a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes, Khunti and colleagues have reported that the use of SUs marginally but significantly reduced COVID-19 mortality whereas this was not observed for glinides [ 19 ].…”

“…In light of these experimental premises, GLP-1RA could be considered an ideal drug to counteract the pro-inflammatory cytokine response after severe COVID-19 infection. Five retrospective studies are available on the effect of GLP-1RA on COVID-19-related mortality [ 19 , 25 , 26 , 39 , 49 ]. None of these show that the use of GLP-1 before SARS-CoV-2 infection could potentially interfere with the disease's course.…”

Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study

“…However, our results suggested that some of these therapies could alter COVID-19 outcomes differently in women and men. Thus, the reduced risk of death associated with metformin use, already reported in the whole CORONADO population (28,39), was only observed in men. This contrasts with a recent retrospective study suggesting that metformin is associated with better survival specifically in women (40).…”