Preexisting and new-onset diabetes in patients with COVID-19 pneumonia

Laurenzi, A.; Caretto, A.; Molinari, C.; Bazzigaluppi, E.; Brigatti, C.; Marzinotto, I.; Mercalli, A.; Melzi, R.; Nano, R.; Tresoldi, C.; Landoni, G.; Ciceri, F.; Lampasona, V.; Scavini, M.; Piemonti, L.

Objective. The aim of the current study was to compare clinical characteristics, laboratory findings and major outcomes of patients hospitalized for COVID-19 pneumonia with new-onset or preexisting diabetes. Design. A cohort of 176 adult patients with a diagnosis of pre-existing (n=112) or new-onset diabetes (n=55) and confirmed COVID-19 pneumonia was studied. Clinical outcomes and laboratory findings were analysed according to the presence of preexisting or new-onset diabetes. The time to viral clearance and the persistence of hyperglycemia were assessed during the follow-up after hospital discharge. Results. Patients with new-onset diabetes had lower BMI, significantly less comorbidities and higher levels of inflammatory markers and indicators of multi-organ injury than those with preexisting diabetes. No differences between preexisting and new onset diabetes were evident for symptoms at admission, humoral response against SARS-CoV-2 or autoantibodies to glutamic acid decarboxylase or interferon alpha-4. New-onset diabetes was independently associated with the risk of adverse clinical outcome defined as ICU admission or death (HR 2.11, 95% CI 1.34-3.31; p=0.001), even after adjustment for age, sex and other selected variables associated with COVID-19 severity. Furthermore, we documented a negative association (HR 0.661, 95% CI 0.43-1.02; p=0.063) between new-onset diabetes and the time to swab negativization. During follow-up we observed that in 30% of the patients with new-onset diabetes hyperglycemia reversed when the viral infection resolved. Conclusions. The recognition of new-onset diabetes as a specific clinical entity associated with COVID-19 pneumonia is relevant for early and appropriate patient management and close monitoring for the progression of disease severity.