Diabetes in Japanese COVID-19 Patients as the Primary Factor of Accelerated Progression to Severe State

Kaneko, Shizuka Kita Hideo Motohashi Kazuya Tokumoto Shinsuke Yoko Ueba Eguchi Hideki Tsunematsu Ichiro

During the COVID-19 pandemic, Japanese victims number less than in other countries, perhaps due to gene specifics, aspects of Japanese lifestyle and coagulation system characteristics typically less potent in Japanese than in Caucasians. The Osaka prefectural government stratified patients into mild, moderate and severe, distributing them amongst various alternative accommodation to relieve overburdened hospitals. Hospitalized patients were managed based on national government guidelines. Focusing on moderate patients, i.e., whose oxygen saturation levels were favorable even if presenting characteristics in computed tomography, we conducted a retrospective analysis in type 2 diabetes (T2D) patients compared with a control. Of a study total of 102 patients (male 51%, aged 62.2±16.0, BMI 27.6±5.2), 49% were T2D patients (aged 71.2±13.8, A1c 6.8±1.3%, BMI 24.5±5.2). Twenty-five patients (24.5%) moved to the severe classification. Eighteen patients (17.6%) (aged 74.8±8.6, A1c 6.9±1.0%, BMI 24.3±2.5), of whom 88.9% had T2D (aged 76.1±10.2, A1c 6.7±1.1%, BMI 23.8±10.2), were ventilated and transferred to another hospital for advanced treatment. Seven patients (6.9%), of whom 71.4% had T2D, died (aged 85±3.4) after ventilation was declined by the families due to advanced age and dementia. One scleroderma patient on home oxygen therapy for intestinal pneumonia died of sudden respiratory failure. Twenty-five diabetes patients (24.5%) improved. No significant correlation exists between hypertension, body mass index, lung disease, renal failure and receiving insulin therapy. In our study, 88% of moderate patients moving to the severe classification had T2D. In Japanese, diabetes may constitute a much larger risk factor than those factors identified in other countries in the evolution of COVID-19 patients from the moderate to severe classifications. A more comprehensive study is needed. BMI: body mass index, A1c: hemoglobin A1c.