IDF21-0593 COVID-19 hospitalizations and cardio-cerebrovascular complications at three months in people with diabetes

Abstract

Background: Scientific research highlighted a high prevalence of concomitant conditions, including diabetes, among patients with severe/fatal COVID-19 manifestations. Considering the high worldwide prevalence of this condition, people with diabetes and COVID-19 could represent a large vulnerable segment of the COVID-19 patients. Thus, it is essential to assess the burden of SARS-CoV-2 infection in people with diabetes to adopt the appropriate measures to mitigate its impact. Aim: The aims of the study are to assess the probability of being admitted to Intensive Care Units (ICUs) for patients with and without diabetes during their first hospitalization for COVID-19 and to evaluate the three-month risk of hospitalization for cardio-cerebrovascular complications in those who survived COVID-19 hospitalization. Method: Population-based observational study. Residents aged ≥18 years of the Local Health Authority of Romagna (Emilia-Romagna, Italy) were considered. Using regional administrative databases, the annual incidence of hospitalization for COVID-19 with 95% confidence interval (95% CI) was estimated in a prevalent cohort of patients with diabetes (those with at least one hospitalization for diabetes or at least two distinct drug prescriptions of Glucose-Lowering Medication in the previous two years from 15/02/2020). In patients hospitalized for COVID-19 with and without diabetes a multiple logistic regression was used to assess the probability of being admitted to ICUs, adjusting for sex, age and Elixhauser comorbidities. Multiple Cox regression was used to evaluate the risk of cardio-cerebrovascular hospitalization at three-month in patients with and without diabetes who survived the first COVID-19 hospitalization, adjusting for sex, age, previous cardio-cerebrovascular disease and other comorbidities, ICU care, and COVID-19 hospitalization length of stay. Results: From 15/02/2020 to 14/02/2021, 942 (1.5%) over 61,886 patients with diabetes had a hospitalization with a COVID-19 diagnosis, with an annual incidence of 4.27 (95% CI [4.01; 4.55]) per 100,000 person-days. Among all patients hospitalized for COVID-19 (n=5,166), multiple logistic regression showed that patients with diabetes had a 35% higher likelihood of being admitted to ICUs as compared with those without diabetes (OR=1.35; 95% CI [1.03; 1.76]). In patients who survived the first COVID-19 hospitalization (n=3,983), multiple Cox regression show no difference in the three-month risk of cardio-cerebrovascular hospitalization between patients with and without diabetes (HR=1.13; 95% CI [0.70; 1.80]). Discussion: Our results showed that during COVID-19 hospitalization people with diabetes were more likely, ceteris paribus, to be admitted to ICUs compared with people without diabetes. No differences in terms of cardio-cerebrovascular complications at three months after COVID-19 hospitalization discharge were found. Our findings demonstrate the huge burden of SARS-CoV-2 infection on people with diabetes, highlighting the challenge that this infection could pose to the clinical management of these patients. Non-pharmaceutical interventions and preventive measures are essential to avoid the infection and the prioritization of this subgroup should be considered when planning vaccination campaigns. Multiple factors could contribute to a worse prognosis of COVID-19 in people with diabetes and further research is needed to investigate their specific role to deepen our knowledge, ensuring that healthcare services are prepared to address the needs of this segment of the population.