A study has identified older age, obesity, heart disease and use of steroids and SGLT2 inhibitors prior to hospitalization for Covid-19 as factors that increase the risk of severe Covid-19 in persons with diabetes. These findings from a retrospective study were presented at the recently concluded annual meeting of the American Association of Clinical Endocrinology (AACE) (May 26-29, 2021 virtual meeting).

Patients who had blood glucose levels out of the reference range had greater chances of developing severe infection. About 44% of diabetic patients with severe Covid-19 had glucose levels > 180 mg/dL compared to 38% of those who did not have severe infection. Patients with severe Covid-19 also had more hypoglycaemic episodes compared to patients who did not have severe infection (9.75% vs 8.90%).

The multicenter study analysed 1818 people with diabetes who were hospitalized with COVID-19. Patients who required intensive care, or met clinical criteria indicating acute respiratory distress syndrome (ARDS) or tachypnea (respiratory rate >30) or SpO2 <93% or PF ratio <300 or those who died were categorised as severe COVID-19.

History of use of an SGLT-2 inhibitor (such as canagliflozin, empagliflozin, dapagliflozin) prior to hospitalization for Covid-19 was associated with an 85% greater chance of having a severe COVID-19 infection (OR = 1.85). A similar high risk of severe Covid-19 was observed with pre-hospitalization exposure to steroids (OR = 1.49). No such association was seen with use of ACEIs (OR 0.75) or statin (OR 0.66).

Older people with diabetes (OR = 1.01) were more likely to have severe disease as did males (OR = 1.37).

A significantly increased risk for severe Covid-19 infection was seen in obese persons with BMI >35 kg/m2 (OR = 1.83) or those having neuropathy (OR = 1.65) or heart disease (OR = 1.3). 

The study authors are hopeful that their study findings would help in better triage of patients with diabetes at greater risk of severe Covid-19 for timely and intensive clinical interventions to improve outcomes in this group of patients.

(Source: Medpage Today, May 28, 2021)

Dr Sanjay Kalra,

DM, Bharti Hospital, KarnalImmediate Past President, Endocrine Society of India