Risk Factors for Poor Outcomes of Diabetes Patients With COVID-19: A Single-Center, Retrospective Study in Early Outbreak in China

Zhang, Nan; Wang, Cheng; Zhu, Feng; Mao, Hong; Bai, Peng; Chen, Lu Lu; Zeng, Tianshu; Peng, Miao; Qiu, Kang Li; Wang, Yixuan; Yu, Muqing; Xu, Shuyun; Zhao, Jianping; Li, Na; Zhou, Min

doi:10.3389/fendo.2020.571037

Cited by 29 publications

(38 citation statements)

References 19 publications

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“…Nevertheless, for diabetes, there is a slightly higher association in the Centre, South, and Yucatan peninsula. The associations have also been reported in other studies in other geographical regions [31][32][33], and although it is still under study, they may be associated with inflammatory stages [34]. Finally, the proportion of individuals between 10 and 39 years old has a relatively similar effect throughout Mexico.…”

Section: Discussionsupporting

confidence: 78%

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

et al. 2021

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COVID-19 is a respiratory disease caused by SARS-CoV-2, which has significantly impacted economic and public healthcare systems worldwide. SARS-CoV-2 is highly lethal in older adults (>65 years old) and in cases with underlying medical conditions, including chronic respiratory diseases, immunosuppression, and cardio-metabolic diseases, including severe obesity, diabetes, and hypertension. The course of the COVID-19 pandemic in Mexico has led to many fatal cases in younger patients attributable to cardio-metabolic conditions. Thus, in the present study, we aimed to perform an early spatial epidemiological analysis for the COVID-19 outbreak in Mexico. Firstly, to evaluate how mortality risk from COVID-19 among tested individuals (MRt) is geographically distributed and secondly, to analyze the association of spatial predictors of MRt across different states in Mexico, controlling for the severity of the disease. Among health-related variables, diabetes and obesity were positively associated with COVID-19 fatality. When analyzing Mexico as a whole, we identified that both the percentages of external and internal migration had positive associations with early COVID-19 mortality risk with external migration having the second-highest positive association. As an indirect measure of urbanicity, population density, and overcrowding in households, the physicians-to-population ratio has the highest positive association with MRt. In contrast, the percentage of individuals in the age group between 10 to 39 years had a negative association with MRt. Geographically, Quintana Roo, Baja California, Chihuahua, and Tabasco (until April 2020) had higher MRt and standardized mortality ratios, suggesting that risks in these states were above what was nationally expected. Additionally, the strength of the association between some spatial predictors and the COVID-19 fatality risk varied by zone.

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Section: Discussionsupporting

confidence: 78%

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

et al. 2021

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“…Our findings correlate with previous evidence that found an association of DM with a higher risk of severe pneumonia in 16-40%. 26,28 They were also found in the literature to have a greater occurrence of ARDS, acute heart injury, acute kidney injury, septic shock, and disseminated intravascular coagulation. 11 McGurnagha et al reported that DM was associated with an OR of 1.395 for fatal or critical care unit treated COVID-19.…”

Section: Effect Of Possible Risk Factors On the Severity And Outcome In Diabetic Groupmentioning

confidence: 93%

The Impact of Diabetes Mellitus and Hyperglycemia on the Severity and Outcome of Patients with COVID-19 Disease: A Single-Center Experience

Argan¹,

Alkhafaji²,

Al-Elq³

et al. 2021

IJGM

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Purpose: Diabetes mellitus (DM) has been reported to be associated with a worse outcome of COVID-19 infection. The evidence is scarce in the Middle East and Saudi Arabia. We aimed to evaluate the impact of diabetes mellitus and hyperglycemia in non-diabetic individuals on the severity and outcome of COVID-19 infection. Methods: This is a retrospective observational study, which included patients with confirmed COVID-19 infection [RT-PCR positive for SARS-CoV2] who were admitted to King Fahd Hospital of the University-Khobar-Eastern Province-Saudi Arabia from March to September 2020. Baseline demographic data, laboratory investigations, and markers of the severity of COVID-19 were analyzed. The collected data were categorized according to the Saudi Arabian Ministry of Health COVID-19 infection severity criteria. Patients were divided into three groups as follows: patients in Group 1 had pre-existing DM, patients in Group 2 did not have DM but were documented to have hyperglycemia at presentation, and patients in Group 3 were neither diabetics nor hyperglycemics at presentation and served as the control group. The severity and outcome of the control group were compared with the other two groups. The effect of risk factors on the severity and outcome of COVID-19 infection was studied in the DM group. Results: A total of 414 patients were included (70.5% males and 29.5% females). The mean age (SD) of patients was 52.3 (±15.5) years. Compared to the control group, pre-existing DM was found to be significantly associated with severe (OR 3.61), critical disease (OR 4.32), intensive care unit (ICU) admission (OR 2.0), and death (OR 2.0) from COVID-19 infection. Hyperglycemia without known DM was also found to be associated with critical COVID-19 pneumonia (P 0.001), and had longer duration of hospitalization (P 0.014), higher ICU admission, mechanical ventilation, and death from COVID-19 infection (P < 0.0001). Conclusion: Diabetes mellitus and hyperglycemia at presentation, even in the absence of preexisting DM, are independent risk factors for disease severity and worse outcome of COVID-19 infection. These patients should be identified and managed accordingly. The COVID-19 vaccination program should also target those populations to improve their outcomes.

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“…To examine the association between metformin use and other outcomes, we conducted a further meta-analyses of two (33,52), five (35,38,39,41,48,49), and four (29)(30)(31)47) studies estimating the association between metformin use and risk of intubation, deterioration, and hospitalization. The pooled ORs of metformin use with intubation, deterioration, and hospitalization were 0.94 (95% CI, 0.77-1.16; I 2 = 0.0%), 2.04 (95% CI, 0.65-6.34; I 2 = 79.4%), and 0.73 (95% CI, 0.53-1.00; I 2 = 16.8%), respectively (Supplementary Figures 2-4).…”

Section: Metformin Use and Other Covid-19 Outcomesmentioning

confidence: 99%

Metformin in Patients With COVID-19: A Systematic Review and Meta-Analysis

Yang

Yan

et al. 2021

Front. Med.

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Importance/Background: The coronavirus disease (COVID-19) pandemic is a critical public health issue. Evidence has shown that metformin favorably influences COVID-19 outcomes. This study aimed to assess the benefits and risks of metformin in COVID-19 patients.Methods: We searched the PubMed, Embase, Cochrane Library, and Chinese Biomedical Literature Database from inception to February 18, 2021. Observational studies assessing the association between metformin use and the outcomes of COVID-19 patients were included. The primary outcome was mortality, and the secondary outcomes included intubation, deterioration, and hospitalization. Random-effects weighted models were used to pool the specific effect sizes. Subgroup analyses were conducted by stratifying the meta-analysis by region, diabetic status, the adoption of multivariate model, age, risk of bias, and timing for adding metformin.Results: We identified 28 studies with 2,910,462 participants. Meta-analysis of 19 studies showed that metformin is associated with 34% lower COVID-19 mortality [odds ratio (OR), 0.66; 95% confidence interval (CI), 0.56–0.78; I2 = 67.9%] and 27% lower hospitalization rate (pooled OR, 0.73; 95% CI, 0.53–1.00; I2 = 16.8%). However, we did not identify any subgroup effects. The meta-analysis did not identify statistically significant association between metformin and intubation and deterioration of COVID-19 (OR, 0.94; 95% CI, 0.77–1.16; I2 = 0.0% for intubation and OR, 2.04; 95% CI, 0.65–6.34; I2 = 79.4% for deterioration of COVID-19), respectively.Conclusions: Metformin use among COVID-19 patients was associated with a reduced risk of mortality and hospitalization. Our findings suggest a relative benefit for metformin use in nursing home and hospitalized COVID-19 patients. However, randomized controlled trials are warranted to confirm the association between metformin use and COVID-19 outcomes.Study Registration: The study was registered on the PROSPERO on Feb 23, 2021 (CRD42021238722).

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Risk Factors for Poor Outcomes of Diabetes Patients With COVID-19: A Single-Center, Retrospective Study in Early Outbreak in China

Cited by 29 publications

References 19 publications

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

The Impact of Diabetes Mellitus and Hyperglycemia on the Severity and Outcome of Patients with COVID-19 Disease: A Single-Center Experience

Metformin in Patients With COVID-19: A Systematic Review and Meta-Analysis

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