Fleischer Institute for Diabetes and Metabolism, New York Regional Center for Diabetes Translation Research, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
Diabetes Care. 2020 Oct;43(10):2339-2344. doi: 10.2337/dc20-1543. Epub 2020 Aug 7.
To examine whether HbA, outpatient diabetes treatment regimen, demographics, and clinical characteristics are associated with mortality in hospitalized patients with diabetes and coronavirus disease 2019 (COVID-19).
This was a retrospective cohort analysis of patients with diabetes hospitalized with confirmed COVID-19 infection from 11 March to 7 May 2020 at a large academic medical center in New York City. Multivariate modeling was used to assess the independent association of HbA levels and outpatient diabetes treatment regimen with mortality, in addition to independent effects of demographic and clinical characteristics.
We included 1,126 hospitalized patients with diabetes and COVID-19 for analysis, among whom mean age was 68 years, 50% were male, 75% were Black, mean BMI was 30 kg/m, 98% had type 2 diabetes, mean HbA was 7.5%, and 33.1% died. HbA levels were not associated with mortality in unadjusted or adjusted analyses, but an outpatient regimen with any insulin treatment was strongly predictive. Additionally, age, sex, and BMI interacted such that in all age categories, mortality was higher with increasing BMI in males compared with females.
In this large U.S. cohort of hospitalized patients with diabetes and COVID-19, insulin treatment, as a possible proxy for diabetes duration, and obesity rather than long-term glycemic control were predictive of mortality. Further investigation of underlying mechanisms of mortality and inpatient glycemic control is needed.
研究血红蛋白 A（HbA）、门诊糖尿病治疗方案、人口统计学和临床特征是否与住院的 2019 冠状病毒病（COVID-19）合并糖尿病患者的死亡率相关。
这是一项回顾性队列分析，纳入了 2020 年 3 月 11 日至 5 月 7 日期间，在纽约市一家大型学术医疗中心住院的经确诊合并 COVID-19 感染的糖尿病患者。采用多变量模型评估 HbA 水平和门诊糖尿病治疗方案与死亡率的独立相关性，此外还评估了人口统计学和临床特征的独立影响。
我们纳入了 1126 例合并 COVID-19 的住院糖尿病患者进行分析，其平均年龄为 68 岁，50%为男性，75%为黑人，平均 BMI 为 30 kg/m2，98%患有 2 型糖尿病，平均 HbA 为 7.5%，有 33.1%的患者死亡。HbA 水平在未经调整或调整后的分析中均与死亡率无关，但任何胰岛素治疗的门诊治疗方案均具有强烈的预测性。此外，年龄、性别和 BMI 之间存在交互作用，即无论年龄大小，男性的 BMI 越高，死亡率越高。
在这项美国大型住院的 COVID-19 合并糖尿病患者队列中，胰岛素治疗（可能是糖尿病病程的替代指标）和肥胖而非长期血糖控制是死亡率的预测因素。需要进一步研究死亡率和住院期间血糖控制的潜在机制。
