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Impact of Comorbidities, Glycemia at Admission and DPP4 Inhibitors in Type 2 Diabetic Patients with COVID-19: a Case Series from an Academic Hospital in Lombardy, Italy

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posted on 06.10.2020 by Marco Mirani, Giuseppe Favacchio, Flaminia Carrone, Nazarena Betella, Emilia Biamonte, Emanuela Morenghi, Gherardo Mazziotti, Andrea Gerardo Lania
OBJECTIVE

Diabetes mellitus may unfavorably influence the outcome of Coronavirus disease-19 (COVID-19), but the determinants of this effect are still poorly understood.

In this monocentric study we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels and antidiabetic medications on the survival of COVID-19 patients.

RESEARCH DESIGN AND METHODS

This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) pandemic in Italy, between February 20 and April 9, 2020.

Medical history, pharmacological treatments, laboratory findings and clinical outcomes of non-diabetic and type 2 diabetic patients were compared. Cox proportional hazards analysis was applied to investigate risk factors associate with mortality.

RESULTS

Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of non-diabetic subjects (42.3% vs 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension [adjusted hazard ratio (aHR) 1.84, 95% confidence interval (C.I.) 1.15-2.95; P = 0.011), coronary artery disease (aHR 1.56, 95% C.I. 1.04-2.35; P = 0.031), chronic kidney disease (aHR 2.07, 95% C.I. 1.27-3.38; P = 0.003), stroke (aHR 2.09, 95% C.I. 1.23-3.55; P=0.006) and cancer (aHR 1.57, 95% C.I. 1.08-2.42; P = 0.04), but not with type 2 diabetes (P = 0.170).

In diabetic patients, elevated plasma glucose (aHR 1.22, 95% C.I. 1.04 – 1.44 per mmol/l; P = 0.015) and IL-6 levels at admission [aHR 2.47, 95% C.I. 1.28 – 4.78 per 1 standard deviation (SD) increase, P = 0.007] as well as treatments with insulin (aHR 3.05, 95% C.I. 1.57-5.95; P = 0.001) and beta-blockers (aHR 3.20, 95% C.I. 1.50-6.60; P = 0.001) were independently associated with an increased mortality, whereas the use of DPP-4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% C.I. 0.02 – 0.92, P = 0.042).

CONCLUSIONS

Plasma glucose levels at admission and antidiabetic drugs may influence the survival of COVID-19 patients affected by type-2 diabetes.


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