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Latest data on Covid-19 patients with diabetes indicate that one in five die within 28 days of hospital admission, according to researchers from France.
Updated results from a study analysing the outcomes of patients with diabetes admitted to hospital with Covid-19 shows that, while around half were discharged, one in five died within 28 days.
“The identification of favourable variables associated with hospital discharge and unfavourable variables associated with death can lead to patient reclassification”
Last year, preliminary data from the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study suggested 10% of patients with diabetes and Covid-19 died within seven days of admission.
The updated analysis, revealed this week, included 2,796 participants from 68 centres across France, with a mean age of 70 years and median body mass index indicating they were overweight.
Microvascular and macrovascular diabetic complications were found in 44% and 39% of participants, respectively, according to the study authors.
Within 28 days, 1,404 (50%) of the patients were discharged from hospital with a median duration of hospital stay of nine days, while 577 participants died (21%).
Of the remaining patients, 12% remained in hospital at day 28, while 17% had been transferred to other facilities that were different to their initial hospital.
Computer modelling revealed various factors such as younger age, routine therapy with metformin and longer symptom duration on admission were associated with a higher chance of discharge.
History of microvascular complications, routine anticoagulant therapy, shortness of breath on admission, abnormal levels of liver enzymes, higher white blood cell counts and higher levels of the systemic inflammatory marker C-reactive protein were all associated with a lower chance of discharge and a higher risk of death.
Patients whose diabetes was regularly treated with insulin – possibly indicating more advanced diabetes – were at a 44% increased risk of death, compared with those not treated with insulin.
The researchers highlighted that an unusual finding from the study was a 42% increased risk of death for patients with diabetes receiving statin treatment for high cholesterol.
However, they flagged that, since this was an observational study, it was difficult to make definite conclusions about any relationship with statins, or any other treatment.
The study also found that long-term blood sugar control assessed with pre-admission or admission HbA1c showed no significant association with death or with discharge within 28 days.
In contrast, an increased level of plasma glucose on admission was a strong predictor of death and, consistently, of a lower chance of discharge, noted the researchers.
The study was led by Professor Bertrand Cariou and Professor Samy Hadjadj, diabetologists at l’institut du thorax at the University Hospital Nantes.
They said: “Regarding death, we reported a mortality rate of 11.2% within 7 days which reached 20.6% within 28 days. These findings can be compared to international reports.
“The identification of favourable variables associated with hospital discharge and unfavourable variables associated with death can lead to patient reclassification and help to use resources adequately according to individual patient profile.
“Our results also establish an association between routine therapy and chance of discharge or risk of death,” they said. “Interestingly, metformin was associated with favourable outcomes.
“Conversely, statin use was associated with higher risk of death and anticoagulation therapy with a reduced chance of discharge. The findings with statins are surprising,” they added.
The new findings from the CORONADO study are published in Diabetologia, the journal of the European Association for the Study of Diabetes.