Ever since the COVID-19 coronavirus pandemic began earlier this year, members of the diabetes care community have been turning their attention to the ways in which the virus might affect diabetes patients. Earlier this year, this column reported on a study published in the British medical journal Lancet that looked at three preliminary reports suggesting people with diabetes might be at a higher risk of contracting the virus, possibly because the drugs known as ACE inhibitors might predispose users to contracting the coronavirus. But the number of subjects in these reports was small and the link between ACE inhibitors and COVID-19 was nothing more than a guess.
To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, sign up for our free newsletter!
Now, however, researchers in France have released the first study of COVID-19 to explicitly address the issue of how the virus has affected hospitalized patients with diabetes. The report is called the CORONADO study, which stands for Coronavirus Sarscov & Diabetes Outcomes, and it was published in Diabetologia, the journal of the European Association for the Study of Diabetes.
The study looked at 1,317 patients with diabetes who were admitted to 53 French hospitals, both public and private, between March 10 and March 30, 2020. Nearly nine of ten patients had type 2 diabetes. About 3% had type 1 diabetes and the rest had other types of diabetes. In 3% of the cases the presence of diabetes was discovered while the patients were being treated in the hospital for COVID-19. The average age of the patients was 70.
The first unexpected discovery was that two out of three of the COVID patients (65%) were men. Interestingly, worse blood sugar control didn’t appear to affect a patient’s outcome, although complications of diabetes and increasing age did raise the risk of death.
By the seventh day of the study, one in five patients (20%) were in intensive care and on a mechanical ventilator; about the same number (18%) had been discharged. One in ten (10.3%) had died. Patients who had microvascular problems (eye, kidney, and nerves) or macrovascular problems (arteries of the heart, brain and legs) were more than twice as likely to die by day seven. Also, patients with breathing problems, such as sleep apnea and shortness of breath, were nearly three times as likely to die. Not surprisingly, the older patients were more likely to die — those 75 and over were 14 times more likely to die than patients under 55. Also not surprisingly, a higher body-mass index (BMI, a determination of overweight or obesity) was associated with both a higher risk of needing mechanical ventilation and of death. As the authors put it, “The risk factors for severe form of COVID-19 are identical to those found in the general population: age and BMI.”
The authors did report a couple of encouraging findings. For one, the use of insulin and other ways of controlling blood sugar (metformin, for example) were not found to be a risk factor for severe forms of the virus, and the authors said that the use of such medications should be continued in COVID-19 patients with diabetes. Also, no type 1 diabetes patients who were under 65 died, although the researchers pointed out that the sample size — just 39 — was too small to draw any conclusions from that finding.
In summing up, the study authors wrote, “Elderly populations with long-term diabetes complications and/or treated obstructive sleep apnea were particularly at risk of early death, and might require specific management to avoid infection with the novel coronavirus. BMI also appears as an independent prognostic factor for COVID-19 severity in the population living with diabetes requiring hospital admission. The link between obesity and COVID-19 requires further study.”
This summer the researchers plan to publish additional research on a larger group of COVID-19 patients with diabetes — some 3,000. This study will look at patient outcomes after 28 days and make more comprehensive comparisons between patients with and without diabetes.
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”