Research published in Diabetology & Metabolic Syndrome reports that diabetic patients on home insulin with COVID-19 pneumonia have worse outcomes and increased mortality compared to diabetics on antihyperglycemic agents.
Diabetes mellitus is a systemic disease, affecting many organs and is associated with insulin resistance in addition to metabolic syndrome which are stated as major risk factors for severe COVID-19 illness. A systematic review has shown that mortality rate in hospitalized patients is higher among diabetic patients compared to non-diabetic [It remains unclear whether all type II diabetic patients share the same risk or those with poorly controlled disease are at higher risk.
To focus our study on the effect of insulin resistance and inflammatory state in diabetic patients, we excluded patients with concomitant chronic respiratory disease , atrial fibrillation, end-Stage Renal Disease , which is defined as mild when the ratio of arterial oxygen partial pressure to fraction of oxygen in inspired air is more than 200 mmHg, moderate when PaO2/FiO2 is between 100 and 200 mmHg and severe when the ratio is below 100 mmHg.
To determine the effect of the diabetes and diabetes treatment on COVID disease and response to treatment we compared diabetic patients on home insulin and non-insulin user diabetics . In addition, to identify predictors of worse outcomes and death, we compared diabetic patients who died versus those who survived COVID-19 infection in a univariate and a multivariate Cox regression model. Results were reported as hazard ratios , corresponding 95% confidence intervals , and p values.
Out of the 696 patients 14% were smokers, 69% had pre- existing hypertension, 45% were on angiotensin converting enzyme inhibitor or angiotensin II receptor blockers , 33% were on home insulin and 51% were on metformin. Throughout their hospital stay, the prevalence of intubation reported was 24% and of AKI was 43%. The mortality rate of this patient population was 12% (Table