Diabetic Patients with COVID-19, Characteristics and Outcome: A Two-Centre, Retrospective, Case Control Study

Background: Since December 2019, a pneumonia caused by SARS-CoV-2 which was later named as COVID-19 emerged and many people lost their lives in Wuhan, China. Diabetes is a common comorbidity in patients with COVID-19. We aim to describe demographic, clinical characteristics and outcomes of SARS-CoV-2 infected patients with diabetes. Methods: This two-centre, retrospective, case control study was carried out at Renmin Hospital of Wuhan University and Zhongnan Hospital of Wuhan University. Diabetic patients confirmed with COVID-19 that discharged or died from January 1, 2020 to February 25, 2020 were enrolled. One SARS-CoV-2 infected patient without diabetes matched by age and sex was randomly selected for each diabetic patient. Data collected included demographic and clinical characteristics, laboratory parameters, outcomes, clinical course and treatment. Findings: Of patients confirmed with COVID-19, 79 (9·6%) were diabetic patients. Median age was 66 (IQR, 56·0-73·3) years. Mortality of diabetic and matched non-diabetic patients were 35·4% and 20·3%, respectively. SARS-CoV-2 infected patients with diabetes were more likely to have underlying comorbidities including hypertension and cardiovascular disease. SARS-CoV-2 infected diabetic patients were prone to develop complications including ARDS (31[39·2%] vs 16 [20·3%]), acute cardiac injury (37 [46·8%] vs 18 [22·8%]), AKI (14 [17·7%] vs 5 [6·3%]), secondary infection (34 [43·0%] vs 17 [21·5%]) and shock (28 [35·4%)] vs 16 [20·3%]). Among SARS-CoV-2 infected diabetic patients, non-survivors were older (74·5 vs 63 years) and were more likely to have underlying medical conditions. Non-survivors reported higher random average blood glucose (13·5 vs 7·3 mmol/L) during hospitalization. Compared with diabetic survivors, higher proportions of occurrence of complications including ARDS (28 [100·0%] vs 3 [5·9%]), acute cardiac injury (27 [96·4%] vs 10 [19·6%]), AKI (14 [50·0%] vs 0), secondary infection (21 [75·0%] vs 13 [25·5%]) and shock (27 [96·4%] vs 1 [2·0%]) were found in non-survivors. Interpretation: The mortality of diabetic patients with COVID-19 was 35·4%, and diabetic patients were prone to suffer multi-organ dysfunction, secondary infection and worse outcome. Diabetes the disease itself, together with old age, other underlying comorbidities and poor glycemic control during hospitalization contributed to the poor outcomes of diabetic patients with COVID-19. Funding Statement: This study was funded by National Natural Science Foundation of China (No·81800574; No·81870442). Declaration of Interests: All authors declared no conflict of interest. Ethics Approval Statement: This study was approved by the institutional ethics board of Renmin Hospital of Wuhan University (No· WDRY2020-K059) and Zhongnan Hospital of Wuhan University (No·2020020).