Patient characteristics
A case series to describe the characteristics of 28 Chinese patients,
mean (SD) age was 68.6 (9.0) years, 75% were males and 50% were
admitted to Intensive care unit (ICU). The HbA1c level was similar
between ICU (7.3%) and non-ICU (7.5%) patients but random blood
glucose concentrations were significantly higher in ICU patients (13.7
mmol/L vs 9.8 mmol/L, p=0.03 respectively). Seventeen (60.7%) patients
had coexisting chronic diseases, including hypertension, heart disease,
cerebrovascular disease, and chronic respiratory disease.14 In another study of 193 Chinese patients with
severe covid-19, 48 of them (24.9%) had diabetes. Compared with
patients without diabetes, those with diabetes were older (70 years vs
60 years, p<0.001), had more comorbidities (60.4% vs 44.8%,
p=0.06), were more likely to receive mechanical ventilation (81.3% vs
49.0%, p<0.001) and had a higher mortality rate (81.3% vs
47.6%, p<0.001). 15 In a Chinese study of
904 patients, 136 (15%) had diabetes, insulin usage was associated with
poor prognosis while the use of angiotensin converting enzyme (ACE)
inhibitors or angiotensin receptor blockers (ARBs) was not associated
with adverse clinical outcomes. 16 Data from the UK of
a total of 3,154,300 patients with diabetes showed that uncontrolled
diabetes (HbA1c >86 mmol/mol vs 48-53 mmol/mol) and obesity
(BMI >40 kg/m2 vs 25-29.9
kg/m2) were independently associated with increased
COVID-19 mortality in both type 1 and type 2 diabetes.17 In the univariate analysis of the French study that
included 1,317 patients with diabetes hospitalised for COVID-19,
characteristics significantly associated with the primary outcome
(mechanical ventilation and/or death within 7 days of admission) were
sex, BMI and previous treatment with renin angiotensin aldosterone
system (RAAS) blockers, but not with age, type of diabetes, HbA1c,
diabetic complications or glucose-lowering therapies. However, in
multivariable analyses, only BMI remained positively associated with the
primary outcome. 18 Data from the US showed that
mortality rate was 28.8% in patients with diabetes or uncontrolled
hyperglycaemia compared to only 6.2% for patients without diabetes or
hyperglycaemia. Also, hyperglycaemia related mortality was 41.7%
compared to 14.8% for patients with diabetes but no hyperglycaemia
suggesting that hyperglycaemia played a crucial role in adverse outcome.19 Characteristics of patients with diabetes and
COVID-19 infection are summarised in Table 2.