Fig. 1Patient selection. COVID-19, coronavirus disease 2019; DM, diabetes mellitus.
Fig. 2Diabetes mellitus (DM) and age as a risk factor for severe and critical outcomes in patients with coronavirus disease 2019. Severe and critical outcomes: composite outcome of acute respiratory distress syndrome, septic shock, intensive care unit care, and mortality within 28 days. Multivariate logistic regression analysis was adjusted by (A) age (<70:≥70 years old), sex, smoking status, and the presence of comorbidities (diabetes mellitus, hypertension, chronic lung disease, and malignancy) in the total number of patients and (B) age (continuous), sex, smoking status, and glycosylated hemoglobin (HbA1c), and serum glucose levels among diabetic patients. The odds ratios (ORs) are presented in log10. CI, confidence interval.
Fig. 3Effects of (A) metformin and (B) RAS inhibitors on severe and critical outcomes, acute cardiac injury, and acute kidney injury in diabetic patients with coronavirus disease 2019. Severe and critical outcomes: composite outcome of acute respiratory distress syndrome, septic shock, intensive care unit care, and mortality within 28 days. Multivariate logistic regression analysis was adjusted by age, sex, smoking status, and glycosylated hemoglobin level. The odds ratios (ORs) are presented in log10. CI, confidence interval.
Table 1Comparison of baseline anthropometric, symptom, and laboratory characteristics between coronavirus disease 2019 patients with and without diabetes
Variable |
All patients (n=110) |
With DM (n=29) |
Without DM (n=81) |
P value |
Age, yr |
56.9±17.0 |
66.3±8.9 |
53.5±17.9 |
<0.001 |
Male sex |
48 (43.6) |
14 (48.3) |
34 (42.0) |
0.664 |
Smoker |
16 (14.5) |
7 (24.1) |
9 (11.1) |
0.123 |
Packs per year |
29.2±26.7 |
26.6±17.9 |
31.2±32.9 |
0.918 |
Vital signs on admission |
|
|
|
|
Body temperature, ℃ |
37.2±0.7 |
37.1±0.7 |
37.2±0.6 |
0.501 |
Heart rate, beats/min |
86.0±13.8 |
86.8±15.2 |
85.7±13.3 |
0.719 |
Respiratory rate |
21.0±2.8 |
22.1±4.4 |
20.6±1.9 |
0.085 |
Systolic BP, mm Hg |
128.1±18.6 |
136.2±19.9 |
125.2±17.4 |
0.006 |
Diastolic BP, mm Hg |
79.9±12.2 |
84.0±13.2 |
78.5±11.6 |
0.038 |
Comorbidities |
|
|
|
|
Hypertension |
37 (33.6) |
16 (55.2) |
21 (25.9) |
0.006 |
Chronic lung disease |
4 (3.6) |
2 (6.9) |
2 (2.5) |
0.283 |
Malignancy |
6 (5.5) |
2 (6.9) |
4 (4.9) |
0.653 |
Cardiovascular disease |
10 (9.1) |
5 (17.2) |
5 (6.2) |
0.125 |
Cerebrovascular disease |
4 (3.6) |
3 (10.3) |
1 (1.2) |
0.055 |
Symptoms on admission |
|
|
|
|
Fever |
62 (56.4) |
16 (55.2) |
46 (56.8) |
1.000 |
Cough |
58 (52.7) |
11 (37.9) |
47 (58.0) |
0.083 |
Sputum |
38 (34.5) |
7 (24.1) |
31 (38.3) |
0.183 |
Myalgia |
37 (33.6) |
8 (27.6) |
29 (35.8) |
0.497 |
Dyspnea |
37 (33.6) |
12 (41.4) |
25 (30.9) |
0.362 |
Headache |
26 (23.6) |
2 (6.9) |
24 (29.6) |
0.020 |
Diarrhea |
11 (10.0) |
1 (3.4) |
10 (12.3) |
0.282 |
Radiological findings |
|
|
|
0.191 |
Unilateral pneumonia |
17 (15.5) |
2 (6.9) |
15 (18.5) |
Bilateral pneumonia |
46 (41.8) |
18 (62.1) |
28 (34.6) |
Multiple ground-glass opacity |
39 (35.5) |
9 (31.0) |
30 (37.0) |
Laboratory results |
|
|
|
|
White blood cell count, ×109/L |
6.7±3.3 |
7.8±2.9 |
6.3±3.4 |
0.040 |
Neutrophil count, ×109/L |
4.7±3.3 |
6.0±3.1 |
4.3±3.3 |
0.022 |
Platelets, ×109/L |
244.1±103.5 |
237.7±92.0 |
246.3±107.8 |
0.700 |
Albumin, g/dL |
3.7±0.6 |
3.4±0.6 |
3.9±0.5 |
<0.001 |
Lactate dehydrogenase, IU/L |
625.9±331.7 |
801.4±453.3 |
559.0±243.7 |
0.010 |
Serum glucose, mg/dL |
133.6±61.8 |
192.1±94.2 |
112.7±20.3 |
<0.001 |
eGFR, mL/min/1.73 m2 (MDRD) |
89.9±23.5 |
82.6±23.8 |
92.5±23.0 |
0.050 |
C-reactive protein, mg/dL |
5.8±8.4 |
9.9±10.2 |
4.3±7.1 |
0.011 |
Procalcitonin, ng/mL |
0.5±2.6 |
1.2±4.6 |
0.2±1.3 |
0.260 |
Table 2Comparison of clinical outcomes and treatment between coronavirus disease 2019 patients with and without diabetes
Variable |
All patients (n=110) |
With DM (n=29) |
Without DM (n=81) |
P value |
Severity scoring |
|
|
|
|
NEWS |
2.5±3.0 |
4.0±4.2 |
1.9±2.1 |
0.015 |
Clinical outcomes |
|
|
|
|
28-day mortality |
6 (5.5) |
5 (17.2) |
1 (1.2) |
0.005 |
ARDS |
18 (16.4) |
11 (37.9) |
7 (8.6) |
0.001 |
Septic shock |
8 (7.3) |
7 (24.1) |
1 (1.2) |
<0.001 |
ICU care |
13 (11.8) |
8 (27.6) |
5 (6.2) |
0.005 |
Acute cardiac injury |
13 (11.8) |
8 (27.6) |
5 (6.2) |
0.005 |
Acute kidney injury |
9 (8.2) |
5 (17.2) |
4 (4.9) |
0.052 |
Treatment |
|
|
|
|
Oxygen |
38 (34.5) |
18 (62.1) |
20 (24.7) |
0.001 |
HFNC |
10 (9.1) |
4 (13.8) |
6 (7.4) |
0.451 |
IMV |
11 (10.0) |
8 (27.6) |
3 (3.7) |
0.001 |
CRRT |
3 (2.7) |
2 (6.9) |
1 (1.2) |
0.169 |
ECMO |
4 (3.6) |
3 (10.3) |
1 (1.2) |
0.055 |
Antibiotics |
108 (98.2) |
27 (93.1) |
81 (100.0) |
0.068 |
Lopinavir/ritonavir |
106 (96.4) |
27 (93.1) |
79 (97.5) |
0.283 |
Hydroxychloroquine |
91 (82.7) |
28 (96.6) |
63 (77.8) |
0.022 |
Glucocorticoid |
21 (19.1) |
8 (27.6) |
13 (16.0) |
0.270 |
Table 3Comparison of clinical characteristics and outcomes between younger (<70 years) and older (≥70 years) coronavirus disease 2019 patients with diabetes
Variable |
Age <70 yr (n=18) |
Age ≥70 yr (n=11) |
P value |
Age, yr |
60.9±6.2 |
75.3±3.6 |
<0.001 |
Male sex |
9 (50) |
4 (36.4) |
0.702 |
HbA1c, % |
7.8±1.7 |
7.36±2.0 |
0.611 |
Serum glucose, mg/dL |
178.9±69.0 |
213.6±126.1 |
0.465 |
DM duration, yr |
2.8±4.4 |
9.0±11.6 |
0.133 |
Newly diagnosed DM |
9 (50.0) |
3 (27.3) |
0.317 |
Medications |
|
|
|
Oral anti-hyperglycemic drugs |
|
|
|
No medication |
10 (58.8) |
3 (30.0) |
0.236 |
On Medication |
7 (41.2) |
7 (70.0) |
|
Metformin |
6 (35.3) |
5 (50.0) |
0.687 |
DPP4i |
5 (29.4) |
1 (10.0) |
0.363 |
Sulfonylurea |
2 (11.8) |
2 (20.0) |
0.613 |
Others (TZD, SGLT2i, AGI) |
2 (11.8) |
2 (20.0) |
0.613 |
Insulin |
1 (10.0) |
0 |
0.675 |
RAS inhibitors |
8 (47.1) |
6 (60.0) |
0.695 |
NEWS |
3.3±4.1 |
5.3±4.5 |
0.204 |
Severe and critical outcomea
|
5 (27.8) |
8 (72.7) |
0.027 |