Kliim-Hansen Vivian, Johansson Karl S, Gasbjerg Laerke S, Jimenez-Solem Espen, Petersen Tonny S, Nyeland Martin E, Winther-Jensen Matilde, Ankarfeldt Mikkel Zöllner, Pedersen Miriam G, Ellegaard Anne-Marie, Knop Filip K, Christensen Mikkel B
Center for Clinical Metabolic Research, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark.
Department of Clinical Pharmacology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Diabetes Obes Metab. 2024 Jan;26(1):160-168. doi: 10.1111/dom.15302. Epub 2023 Oct 5.
To explore the impact of type 2 diabetes (T2D), glycaemic control and use of glucose-lowering medication on clinical outcomes in hospitalized patients with COVID-19.
For all patients admitted to a hospital in the Capital Region of Denmark (1 March 2020 to 1 December 2021) with confirmed COVID-19, we extracted data on mortality, admission to intensive care unit (ICU), demographics, comorbidities, medication use and laboratory tests from the electronic health record system. We compared patients with T2D to patients without diabetes using Cox proportional hazards models adjusted for available confounding variables. Outcomes were 30-day mortality and admission to an ICU. For patients with T2D, we also analysed the association of baseline haemoglobin A1c (HbA1c) levels and use of specific glucose-lowering medications with the outcomes.
In total, 4430 patients were analysed, 1236 with T2D and 2194 without diabetes. The overall 30-day mortality was 19% (n = 850) and 10% (n = 421) were admitted to an ICU. Crude analyses showed that patients with T2D both had increased mortality [hazard ratio (HR) 1.37; 95% CI 1.19-1.58] and increased risk of ICU admission (HR 1.28; 95% CI 1.04-1.57). When adjusted for available confounders, this discrepancy was attenuated for both mortality (adjusted HR 1.13; 95% CI 0.95-1.33) and risk of ICU admission (adjusted HR 1.01; 95% CI 0.79-1.29). Neither baseline haemoglobin A1c nor specific glucose-lowering medication use were significantly associated with the outcomes.
Among those hospitalized for COVID-19, patients with T2D did not have a higher risk of death and ICU admission, when adjusting for confounders.
探讨2型糖尿病（T2D）、血糖控制及降糖药物的使用对COVID-19住院患者临床结局的影响。
对于丹麦首都地区一家医院（2020年3月1日至2021年12月1日）收治的所有确诊COVID-19患者，我们从电子健康记录系统中提取了死亡率、入住重症监护病房（ICU）情况、人口统计学信息、合并症、用药情况及实验室检查数据。我们使用针对可用混杂变量进行调整的Cox比例风险模型，将T2D患者与非糖尿病患者进行比较。结局指标为30天死亡率和入住ICU情况。对于T2D患者，我们还分析了基线糖化血红蛋白（HbA1c）水平及特定降糖药物的使用与结局的关联。
共分析了4430例患者，其中1236例患有T2D，2194例无糖尿病。总体30天死亡率为19%（n = 850），10%（n = 421）入住ICU。粗分析显示，T2D患者的死亡率[风险比（HR）1.37；95%置信区间（CI）1.19 - 1.58]和入住ICU的风险（HR 1.28；95% CI 1.04 - 1.57）均升高。在对可用混杂因素进行调整后，死亡率（调整后HR 1.13；95% CI 0.95 - 1.33）和入住ICU的风险（调整后HR 1.01；95% CI 0.79 - 1.29）的这种差异均有所减弱。基线HbA1c水平及特定降糖药物的使用均与结局无显著关联。
在因COVID-19住院的患者中，调整混杂因素后，T2D患者的死亡风险和入住ICU的风险并不更高。
