In people with type 2 diabetes and chronic kidney disease (CKD) who are hospitalized with COVID-19, certain factors — including blood glucose control and kidney disease severity — are linked to poor outcomes, according to a new study presented at the 2022 American Association of Clinical Endocrinology (AACE) meeting and described in an article at MedPage Today.
For the last couple of years, study after study has shown that people with diabetes tend to experience worse outcomes if they develop COVID-19. But many of those same studies have also made clear that not all people with diabetes face the same risk level for poor outcomes from the viral infection — like hospitalization, admission to the intensive care unit (ICU), or death. People with type 2 diabetes are more likely to be hospitalized with COVID-19 if they have a higher A1C level (a measure of long-term blood glucose control), and long-term blood glucose control — over the previous two to three years — is linked to the risk of needing intensive care for COVID-19. Some drugs for type 2 diabetes are also linked to a lower risk of dying from COVID-19 — particularly metformin or a sulfonylurea. Men with diabetes are also more likely than women to die from COVID-19, as are older people with diabetes compared with younger people.
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For the latest study, researchers looked at data from 3,852 people hospitalized for COVID-19 in a health system in Rhode Island. There were 1,254 participants with type 2 diabetes, with data on kidney function available for 1,122 of them — indicating the presence of kidney disease. Most participants had early-stage kidney disease, while 18.8% had stage 3b disease, 16.3% had stage 4 disease, and 14.4% had stage 5 disease (end-stage disease, or kidney failure).
Those with high blood glucose, more advanced kidney disease at higher risk of poor COVID outcomes
Among participants with diabetes and kidney disease, those with high blood glucose at the time of hospital admission were 10.49 times as likely to develop severe COVID-19 — meaning that they required admission to the ICU, needed mechanical ventilation, or died during their hospital stay. Separately, participants with stage 5 kidney disease — or those who were on dialysis at the time of hospitalization — were 4.67 times as likely to develop severe COVID-19. These links to severe illness were found after the researchers adjusted for participants’ age, sex, race and ethnicity, obesity status, and whether or not they had high blood pressure, pulmonary (lung) disease, or cardiovascular disease.
Participants with stage 5 kidney disease also tended to have the longest hospital stay, an average of about 15 days. Those with stage 3b or stage 4 kidney disease both stayed an average of about 10 days in the hospital, while those with early-stage kidney disease or no kidney disease stayed an average of about eight days. While only 4% of participants with early-stage kidney disease died during their hospital stay, this number increased to 11% for those with stage 3b disease, 21% for those with stage 4 disease, and 29% for those with stage 5 kidney disease.
There was a glimmer of optimism from the study results, though — participants with diabetes and kidney disease were more than twice as likely to develop severe COVID-19 if they were hospitalized early on in the pandemic (before July 2020), compared with during the second wave (July 2020 through February 2021) or third wave (March 2021 to present) of the pandemic. The risk for poor outcomes is expected to continue to fall as hospital treatments improve, and as therapeutic drugs for COVID-19 become more widely available and used.
Want to learn more about coronavirus and diabetes? Read our latest COVID-19 updates.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
