Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

https://doi.org/10.1016/j.diabres.2021.108753Get rights and content

Highlights

  • ā€¢

    Several studies have investigated the factors determining the clinical course of COVID-19.

  • ā€¢

    T2DM worsens the clinical course of COVID-19 and increases the risk of death.

  • ā€¢

    This retrospective population-based study covered all COVID-19 patients seen in Istanbul.

  • ā€¢

    Mortality was relatively low in general population and T2DM patients.

  • ā€¢

    Population dynamics and health system accessibility can reduce mortality rates.

Abstract

Aims

Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul.

Methods

A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality.

Results

Of the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death.

Conclusions

COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population.

Keywords

COVID-19
Hospitalization
Mortality
Type 2 diabetes mellitus
Istanbul

Abbreviations

AHD
Antihyperglycemic drugs
ALT
Alanine aminotransferase
ASA
Acetylsalicylic acid
AST
Aspartate aminotransferase
BMI
Body mass index
CAD
Coronary artery disease
CI
Confidence intervals
CKD
Chronic kidney disease
CKD-EPI
Chronic Kidney Disease Epidemiology Collaboration
COPD
Chronic obstructive pulmonary disease
COVID-19
Coronavirus disease 2019
CRP
C-reactive protein
CT
Computed tomography
CVD
Cardiovascular diseases (including coronary artery disease, peripheral artery disease, and stroke)
eGFR
Estimated glomerular filtration rate
HbA1c
Glycosylated hemoglobin A1c
HDL-chol
High density lipoprotein cholesterol
ICD-10
International Classification of Diseases-10
ICU
Intensive Care Unit
IQR
Interquartile range
LDH
Lactate dehydrogenase
LDL-chol
Low density lipoprotein cholesterol
LMWH
Low molecular weight heparin
Lym
Lymphocytes
MoH
Ministry of Health
Non-DM
Non diabetes mellitus
OR
Odds ratio
PSM
Propensity Score Matching system
rt-PCR
Reverse transcription-polymerase chain reaction
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
SPSS
Statistical Package for the Social Sciences
T2DM
Type 2 diabetes mellitus
ULN
Upper limit of normal

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