Cardiometabolic therapy and mortality in very old patients with diabetes hospitalized due to COVID-19

Ramos-Rincón, Jose Manuel; Pérez-Belmonte, Luis M; Carrasco-Sánchez, Francisco Javier; Jansen-Chaparro, Sergio; De-Sousa-Baena, Mercedes; Bueno-Fonseca, José; Pérez-Aguilar, Maria; Arévalo-Cañas, Coral; Bacete Cebrian, Marta; Méndez-Bailón, Manuel; Fiteni Mera, Isabel; González García, Andrés; Navarro Romero, Francisco; Tuñón de Almeida, Carlota; Muñiz Nicolás, Gemma; González Noya, Amara; Hernández Milian, Almudena; García García, Gema María; Alcalá Pedrajas, José Nicolás; Herrero García, Virginia; Corral-Gudino, Luis; Comas Casanova, Pere; Meijide Míguez, Héctor; Casas-Rojo, José Manuel; Gómez-Huelgas, Ricardo

BACKGROUND: The effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19. METHODS: We conducted a nationwide, multicenter, observational study in patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19 between March 1 and May 29, 2020. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. RESULTS: Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95%CI 0.309-0.815, p=0.005) and angiotensin receptor blockers (AOR 0.454, 95%CI 0.274-0.759, p=0.003) were independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95%CI 1.092-2.842, p=0.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins showed neutral association with in-hospital mortality. CONCLUSIONS: We found important differences between cardiometabolic drugs and in-hospital mortality in older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers could reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins seem to have a neutral effect; and acetylsalicylic acid could be associated with excess mortality.