The impact of type 2 diabetes and its management on the prognosis of patients with severe COVID‐19

Xu, Zihui; Wang, Zhongjing; Wang, Shuo; Ye, Yingchun; Luo, Deng; Wan, Li; Yu, Ailin; Sun, Lifang; Tesfaye, Solomon; Meng, Qingtao; Gao, Ling

BACKGROUND: Although T2DM patients with COVID‐19 develop a more severe condition compared to those without diabetes, the mechanisms for this are unknown. Moreover, the impact of treatment with anti‐hyperglycemic drugs and glucocorticoids is unclear. METHODS: From 1584 COVID‐19 patients, 364 severe/critical COVID‐19 patients with clinical outcome were enrolled for the final analysis and patients without pre‐existing T2DM but elevated glucose levels were excluded. Epidemiological data were obtained and clinical‐status evaluation carried out to assess the impact of T2DM and its management on clinical outcomes. RESULTS: Of 364 enrolled severe COVID‐19 inpatients, 114 (31.3%) cases had a history of T2DM. 27(23.7%) cases died in T2DM patients, who had more severe inflammation, coagulation activation, myocardia injury, hepatic injury, and kidney injury, compared with non‐DM patients. In severe COVID‐19 patients with T2DM, we demonstrate a higher risk of all‐cause fatality with glucocorticoid treatment (Adjusted HR, 3.61; 95%CI, 1.14‐11.46; P = 0.029), and severe hyperglycemia (FPG ≥11.1 mmol/L) (Adjusted HR, 11.86; 95%CI, 1.21‐116.44; P = 0.034). CONCLUSIONS: T2DM status aggravated the clinical condition of COVID‐19 patients and increased their critical illness risk. Poor fasting blood glucose (≥ 11.1 mmol/L) and glucocorticoid treatment are associated with poor prognosis for T2DM patients with severe COVID‐19. This article is protected by copyright. All rights reserved.