Predictors of severe COVID-19 disease in patients with diabetes: a multi-center review

Kristan, Megan M.; Kim, Yoon K.; Nelson, Toby; Moxley, Meaghan C.; Yip, Terry Cheuk-Fung; Munir, Kashif; Malek, Rana

AIMS: Diabetes is an independent risk factor for severe SARS-CoV-2 infections. The goal of this study is to elucidate risk factors predictive of more severe outcomes in these individuals by comparing clinical characteristics of those requiring inpatient admission to those who remain outpatient. METHODS: A retrospective review identified 832 patients — 631 inpatients and 201 outpatients—with diabetes and a positive SARS-CoV-2 test between March 1 and June 15, 2020. Comparisons between the outpatient and inpatient cohorts was conducted to identify risk factors associated with severity of disease determined by admission rate and mortality. Previous DPP-4 inhibitor use and disease outcomes were analyzed. RESULTS: Risk factors for increased admission included older age (OR 1.04 (95% CI 1.01 – 1.06), p = 0.003) presence of chronic kidney disease (OR 2.32 (1.26 – 4.28), p = 0.007), and a higher A1C at time of admission (OR 1.25 (1.12 – 1.39), p <0.001). Lower admission rates were seen in those with commercial insurance. Increased mortality was seen in individuals with older age (OR 1.09 (1.07 – 1.11), p <0.001), BMI (OR 1.04 (1.01- 1.07), p = 0.003), and A1C at time of diagnosis of COVID (OR 1.12 (1.01 – 1.24), p = 0.028) and patients requiring hospitalization. Lower mortality was seen in those with hyperlipidemia. DPP-4 inhibitor use prior to COVID-19 infection was not associated with decreased hospitalization rate. CONCLUSIONS/INTERPRETATION: This retrospective review offers the first analysis of outpatient predictors for admission rate and mortality of COVID-19 illness in patients with diabetes.