Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
Division of Infectious Disease, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
Diabetes Metab J. 2020 Jun;44(3):405-413. doi: 10.4093/dmj.2020.0105. Epub 2020 May 21.
To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.
This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.
After exclusion, 110 participants were finally included. DM patients (=29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771; <0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175; =0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048; =0.045).
The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.
为了确定糖尿病（DM）在 2019 年冠状病毒病（COVID-19）中的作用，我们探讨了糖尿病患者的临床特征，并比较了年龄、血糖控制和药物等危险因素与非糖尿病患者的差异。
这是一项在韩国大邱的一家三级医院进行的回顾性队列研究，共纳入 117 例确诊 COVID-19 患者。主要结局定义为严重和危急结局（SCO），包括急性呼吸窘迫综合征、感染性休克、重症监护病房治疗和 28 天死亡率的复合结局。我们分析了 DM 组中哪些临床特征和血糖控制相关因素影响 COVID-19 的预后。
排除后，最终纳入 110 名参与者。DM 患者（=29）年龄较大，且血压较高。DM 组炎症相关生物标志物和严重程度评分较高，且更易进展为 SCO。在调整其他危险因素后，DM 增加了 SCO 的风险（比值比[OR]，10.771；<0.001）。在 DM 患者中，≥70 岁的老年患者中 SCO 更为常见，年龄是 DM 患者发生 SCO 的独立危险因素（OR，1.175；=0.014），而血糖控制不是。药物使用并未影响 SCO，但肾素-血管紧张素系统抑制剂对急性心脏损伤具有保护作用（OR，0.048；=0.045）。
COVID-19 合并 DM 的患者病情更严重，导致 SCO 发生。需要对 DM 组的 COVID-19 临床结局进行强化和积极监测，特别是在老年患者中。
