Abstract
BackgroundDiabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19.MethodsThis retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was ≥6.5% (48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis.ResultsOf 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs. 5.9%, p < 0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p < 0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥1.0 μg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19.ConclusionsThe prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.
Highlights
MethodsThis retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020
Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes
In this retrospective observational study, we described the prevalence of diabetes, including previously diagnosed and undiagnosed diabetes, in hospitalised patients with COVID-19 at a tertiary medical centre in Wuhan, China
Summary
Study design and population This retrospective study aimed to investigate the impact of diabetes on the prognosis of COVID-19. In Wuhan, critical, severe, and most moderate patients with COVID-19 were directly admitted to tertiary medical centres such as our institution. Patients were transferred to tertiary medical centres for further treatment. We excluded transferred patients from Fangcang hospitals to eliminate bias associated with pre-admission treatments. We excluded patients who lacked records of medical history, vital signs and routine blood test data, and those who had other serious comorbidities (end-stage renal disease or diseases requiring corticosteroid or immunosuppressant therapy) (Fig. 1). Data abstraction Using a standardised data collection form, the epidemiological records, demographic data, clinical manifestations, laboratory findings, treatment, and outcome data of patients with COVID-19 were extracted from electronic medical records. Sensitivity analysis was performed in a subgroup of patients with HbA1c results at admission, and risk factors for in-hospital death were evaluated with logistic regression analysis. A two-sided P value < 0.05 was considered statistically significant
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