key: cord-0970928-8mh9o1gy
authors: Li, F.; Cai, Y.; Gao, C.; Zhou, L.; Chen, R.; Zhang, K.; Li, W.; Zhang, R.; Zhang, X.; Wang, D.; Liu, Y.; Tao, L.
title: Effects of Diabetes and Blood Glucose on COVID-19 Mortality: A Retrospective Observational Study
date: 2021-01-22
journal: nan
DOI: 10.1101/2021.01.21.20202119
sha: 6f378f11ee574d2fe573c2cfa838e991e1ac0422
doc_id: 970928
cord_uid: 8mh9o1gy

OBJECTIVE To investigate the association of diabetes and blood glucose on mortality of patients with Coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS This is a retrospective observational study of all patients with COVID-19 admitted to Huo-Shen-Shan Hospital, Wuhan, China. The hospital was built only for treating COVID-19 and opened on February 5, 2020. The primary endpoint is all-cause mortality during hospitalization. RESULTS Among 2877 hospitalized patients, 15.5% (387/2877) had a history of diabetes and 1.9% (56/2877) died in hospital. After adjustment for confounders, patients with diabetes had a 2-fold increase in the hazard of mortality as compared to patients without diabetes (adjusted HR 2.11, 95%CI: 1.16-3.83, P=0.014). The glucose above 4mmol/L was significantly associated with subsequent mortality on COVID-19(adjusted HR 1.17, 95%CI: 1.10-1.24, per 1mmol/L increase, P<0.001). CONCLUSIONS Diabetes and glucose were associated with increased mortality in patients with COVID-19. These data support that blood glucose should be properly controlled for possibly better survival outcomes in patients with COVID-19.

1 1

prior to the infection of SARS-CoV-2. A medical history of hypertension or blood 1 2 . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 pressure≥140/90mHg on admission were defined as any hypertension . The antidiabetic regimens 1 3

were in principle unchanged during hospitalization whatever the patients had previous 1 4

prescriptions before admission. Discontinuation or alteration of the antidiabetic treatment during 1 5 hospitalization due to the clinical presentation of COVID-19 was at their physician's discretion.

Statistical Analysis 1 7

Continuous variables with normal distribution were expressed as mean (standard deviation) and

1 8 compared using independent student's t-test, and those with skewed distribution were expressed 

Restricted cubic splines were used to explore the relationship between blood glucose and hazard 2 9 of death. As the relationship of predicted blood glucose was approximately linear above and 3 0 below their cutoff, a linear spline model with a node at cutoff was fitted to calculate hazard ratios 3 1

(HR) per mmol/L increase in blood glucose. Analyses were performed using SPSS version 25.0 3 2 . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. 

Compared with patients with non-death, patients with death had higher respiratory rate and more 4 3

likely presented with cough and shortness of breath. As shown in Figure 1and and other clinical endpoints in the COVID-19 patients with or without the above medications.

However, the analysis is underpowered, which might lead to the neutral results. Future dedicated 3 9 study with adequate sample size is needed to further investigate such issue.

First, since our results were based only on admission glucose, it was likely that we had 4 2 underestimated the risks associated with hyperglycemia given that the patients with the highest 4 3 levels of glucose would have been more likely to be treated in the hospital setting.

Second, we did not routinely collect measures of long-term glucose control, such as HbA1c,

which would have allowed us to distinguish long-term poorly controlled diabetic patients from 4 6 those with hyperglycemia as a measure of significant physiological stress.

Third, even though we analyzed one of the largest cohorts of hospitalized patients with 4 8 COVID-19 up to date, we had insufficient numbers to examine the role of various anti-glycemic 4 9

treatments (e.g., insulin, metformin) on outcomes. Our findings should be interpreted cautiously.

Larger scale and dedicated cohort study or RCT were needed to verify our conclusions. 5 1 5 2

In conclusion, diabetes was independently associated with increased mortality, and on-admission 5 4

blood glucose (per mmol/L≥4mmol/L) was also an independent factor for mortality in patients 5 5

with COVID-19. The mortality was not affected by the anti-diabetic medications. These data 5 6 support that, regardless of anti-diabetic medications administrated, proper blood glucose control 5 7

. CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. should be achieved for possibly better outcomes in patients with COVID-19. However, due to 5 8 the observational nature of the study, the results should be interpreted cautiously.

6 0 . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. 1 0 . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. ; https://doi.org/10.1101/2021.01.21.20202119 doi: medRxiv preprint . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted January 22, 2021. ; https://doi.org/10.1101/2021.01.21.20202119 doi: medRxiv preprint 

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