MADRID, 29 Sep. (EUROPA PRESS) –
New research presented at the annual meeting of the European Association for the Study of Diabetes (EASD) has studied whether COVID-19 is more deadly for some people with diabetes than others and has found that type 2 diabetes is associated to a higher risk of mortality in hospitalized COVID patients than type 1 diabetes.
The combination of older age and elevated C-reactive protein (CRP) was also associated with an increased risk of death and younger people (under 70 years) with chronic kidney disease, a common long-term complication of diabetes, they were also more likely to die. The BMI, however, was not related to survival.
This information has been used by researchers to create a simple model that can be used to predict which patients are most at risk of dying.
Although people with diabetes are not more likely to get COVID-19 than others, they are more likely to become seriously ill if they do get it. However, it was not clear whether certain characteristics put some people with diabetes at higher risk of serious illness and death than others.
The ACCREDIT study, conducted by Dr. Daniel Kevin Llanera and Dr. Rebekah Wilmington, of the Countess of Chester NHS Foundation Trust (UK), and their colleagues, looked for the relationship between a number of clinical and biochemical characteristics and the risk of mortality in within seven days of admission to hospital for COVID-19 diabetic patients.
The 1,004 patients from seven North West England hospitals had a mean age of 74.1 years. The majority (60.7%) were male and 45% lived in areas classified as the UK’s most deprived (according to the government’s Multiple Deprivation Index).
The median BMI was 27.6 and 56.2% had macrovascular complications of diabetes (eg, myocardial infarction or stroke) and 49.6% had microvascular complications (eg, neuropathy or retinopathy).
7.5% were admitted to intensive care and 24% died within seven days of admission to the hospital. The greater socioeconomic deprivation and the older age of the patients studied may help explain why mortality at seven days was higher than in other studies, says Dr. Llanera. However, more research is needed to confirm this.
About one in ten patients (9.8%) required insulin infusions, meaning they were switched from other treatments to intravenous insulin to better control their blood sugar.
The analyzes showed that patients with type 2 diabetes were 2.5 times more likely to die within seven days of admission than those with other types of diabetes. The study authors say this may be because type 2 diabetes tends to occur in older people and can be accompanied by other long-term health problems, putting them at higher risk for worse outcomes.
However, those who underwent insulin infusions were half as likely to die as those who did not need intravenous insulin. The study authors say this may be an indication that better glycemic control may improve outcomes in patients with severe COVID and diabetes.
The risk of death was also higher among those younger than 70 with chronic kidney disease. They were 2.74 times more likely to die than those under the age of 70 without chronic kidney disease.
Dr. Llanera recalls that, “according to several studies, patients with diabetic kidney disease have a chronic pro-inflammatory state and immune dysregulation, which makes it difficult to” fight “the virus compared to someone who has a properly functioning immune system” .
“In addition,” he continues, “ACE2 receptors are upregulated in the kidneys of patients with diabetic kidney disease. These are molecules that facilitate the entry of SARS-COV-2 into cells. This can lead to an attack. direct from the kidneys by the virus, possibly leading to worse overall results. “
The combination of advanced age and elevated CRP (a marker of inflammation) was associated with a risk of death more than three times higher (3.44) on the seventh day. The study authors state that a high CRP is correlated with a high degree of inflammation, which can end up causing organ failure.
The data have served to create a model that, if applied to a patient with similar demographic characteristics, can predict an increased risk of death in 7 days using only age and CRP as variables.
Dr. Llanera states that “both variables are readily available during hospital admission. This means that we can easily identify patients in the early stages of their hospital stay who will likely require more aggressive interventions to try to improve survival.”
Unlike some previous studies, BMI and HbA1c (mean blood sugar level) were not associated with death. There was also no significant association with diabetes complications, other than chronic kidney disease, or with the use of ACE inhibitors and angiotensin receptor blockers (ARBs), types of blood pressure medications.
The proportion of patients (9.8%) who switched to insulin infusions is above the typical figure of 8%, suggesting that Covid patients require higher levels of input from inpatient diabetes teams.
Llanera concludes that, “to help our patients with diabetes survive this pandemic, it was necessary to further explore what puts them at risk of having worse outcomes. These results will allow other researchers and clinicians to find out how we can intervene better, which will allow us to offer our patients the most appropriate treatment. “
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