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02-06-2020 | Diabetes | News | Article

Obesity only preadmission factor to influence COVID-19 outcomes in diabetes

Author: Eleanor McDermid

medwireNews: Obesity is the only preadmission factor to have a bearing on outcomes of people with diabetes who are hospitalized with COVID-19, shows the French multicenter CORONADO study.

Notably, only 3% of the 1317 patients included in the study had type 1 diabetes, meaning “there was no overrepresentation” of people with type 1 diabetes in the hospitalized study population, according to the researchers.

“[O]ur data can be considered reassuring for the majority of people living with type 1 diabetes,” say Bertrand Cariou (Hôpital Guillaume et René Laennec, Nantes) and study co-authors in Diabetologia.

“Indeed, there was no death in participants with type 1 diabetes younger than 65 years.”

At the time of analysis, 31.1% of all study participants had been admitted to the intensive care unit, 65.1% of whom required tracheal intubation, which was part of the study’s combined primary endpoint, along with 7-day mortality, which occurred in 10.6% of the whole population.

The median BMI of the cohort was 28.4 kg/m2, and was 29.1 versus 28.1 kg/m2 in patients who did versus did not meet the primary endpoint. On multivariable analysis, BMI was the only preadmission factor to be significantly associated with the primary endpoint, with each standard deviation increase associated with a 28% increase in risk.

However, this was driven largely by its association with tracheal intubation; BMI was not associated with 7-day mortality risk. This latter endpoint was instead predicted by older age, male sex, micro- and macrovascular complications, and treated obstructive sleep apnea.

The researchers note that mortality is an “unequivocal” endpoint, whereas not all patients indicated for intubation may receive it, for reasons such as clinical deterioration, futility, and patient refusal.

They found no relationship between renin–angiotensin–aldosterone system (RAAS) blocker use and outcomes, “supporting the recent recommendation not to discontinue RAAS blockade,” and there was also no association between any class of glucose-lowering drugs and COVID-19 outcomes.

Admission factors significantly associated with the primary outcome included dyspnea, increased liver enzymes, reduced lymphocyte count, and high C-reactive protein levels. Low platelet count and reduced renal function were additionally associated with 7-day mortality only.

Cariou et al note that 11.1% of patients had acute diabetes complications, including 40 incidences of ketosis (of which 19 were ketoacidosis) and 14 of hypoglycemia. Also, 6.3% of patients had severe anorexia.

The team says that “physicians should be warned not only of the risk of ketoacidosis but also of hypoglycaemia, probably favoured by COVID-19-induced anorexia without concomitant adaptation of glucose-lowering drugs.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

2 June 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Diabetologia 2020; doi:10.1007/s00125-020-05180-x