INCREASED MORTALITY ASSOCIATED WITH TREATMENT OF TYPE 2 DIABETES AMONG COVID-19 PATIENTS A SINGLE CENTER STUDY
DOI:
https://doi.org/10.47672/ajhmn.839Keywords:
Increased, mortality, associated, type 2 diabetes, covid-19 patients.Abstract
Purpose: COVID-19 caused by SARS-COV-2 infection can lead to multi-organ injuries and significant mortality in severe and critical patients, especially among those individuals with type 2 diabetes (T2D) as a comorbidity. While attenuated mortality was observed with aggressive glucose control, it was unclear whether therapeutic regimens including insulin treatment were beneficial for patients with COVID-19 and T2D. This retrospective study investigated 320 patients with COVID-19 and T2D from a cohort of 2950 cases from Wuhan, China. Unexpectedly, we found that insulin treatment for patients with COVID-19 and T2D was associated with a significant increase in mortality (23.2% versus 2.5%; adjusted HR, 5.38 [2.75–10.54]). Further analysis showed that insulin treatment was associated with enhanced systemic inflammation and aggravated injuries of vital organs. Therefore, insulin treatment for patients with COVID-19 and T2D should be used with caution.
Methodology: We performed comprehensive literature retrieval from the date of inception until February 2, 2021, in medical databases (Google scholar, Web of Science, Embase, and Cochrane Library), regarding mortality outcomes in patients with T2DM who have COVID-19. Pooled OR and 95% CI data were used to assess relationships between antidiabetic agents and mortality.
Downloads
References
Bramante, C., Ingraham, N., Murray, T., Marmor, S., Hoversten, S., Gronski, J., McNeil, C., Feng, R., Guzman, G., Abdelwahab, N., et al. (2020). Observational study of metformin and risk of mortality in patients hospitalized with Covid-19. medRxiv. https://doi.org/10.1101/2020.06.19.20135095.
Brundage, S.I., Kirilcuk, N.N., Lam, J.C., Spain, D.A., and Zautke, N.A. (2008). Insulin increases the release of pro inflammatory mediators. J. Trauma 65, 367–372.
Chen, M., Li, H., Shen, Y., Liu, B., Yan, R., Sun, X., Ye, L., Lee, K.O., Ma, J., and Su, X. (2020a). Flash glucose monitoring improves glucose control in peoplewith type 2 diabetes mellitus receiving anti-diabetic drug medication. Exp.Clin. Endocrinol. Diabetes 2020, 28.
Badawi A., Ryoo S.G. Prevalence of diabetes in the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus: a systematic review and meta-analysis. J. Public Health Res. 2016;5:733. [PMC free article] [Google scholar] [Google Scholar]
Bode B., Garrett V., Messler J., McFarland R., Crowe J., Booth R., Klonoff D.C. Glycemic characteristics.
Bornstein S.R., Rubino F., Khunti K., Mingrone G., Hopkins D., Birkenfeld A.L., Boehm B., Amiel S., Holt R.I., Skyler J.S. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546–550. [PMC free article] [Google scholar] [Google Scholar]
Bramante C., Ingraham N., Murray T., Marmor S., Hoversten S., Gronski J., McNeil C., Feng R., Guzman G., Abdelwahab N. Observational study of metformin and risk of mortality in patients hospitalized with Covid-19. medRxiv. 2020 doi: 10.1101/2020.06.19.20135095. [CrossRef] [Google Scholar]
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., et al. (2020b). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptivestudy. Lancet 395, 507–513.
Columbia Public Health (2020). Propensity score analysis. https://www. publichealth.columbia.edu/research/population-health-methods/propensityscore- analysis. Diabetes Branch of Chinese Medical Association (2020). Management suggestions for patients with diabetes and novel coronavirus pneumonia. Chin J Diabetes Mellitus 12, 73–75.
Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention (2020). [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi 41, 145–151.
Filgueiras, L.R., Capelozzi, V.L., Martins, J.O., and Jancar, S. (2014). Sepsisinduced lung inflammation is modulated by insulin. BMC Pulm. Med. 14, 177.
Investigators (2009). Intensive versus conventional glucose control in critically ill patients. N. Engl. J. Med. 360, 1283–1297.
Gerstein, H.C., Miller, M.E., Byington, R.P., Goff, D.C., Jr., Bigger, J.T., Buse, J.B., Cushman, W.C., Genuth, S., Ismail-Beigi, F., Grimm, R.H., Jr., et al.; Action to Control Cardiovascular Risk in Diabetes Study Group (2008).Effects of intensive glucose lowering in type 2 diabetes. N. Engl. J. Med.358, 2545–2559.
Guo, L., Shi, Z., Zhang, Y., Wang, C., Do Vale Moreira, N.C., Zuo, H., anHussain, A. (2020a). Comorbid diabetes and the risk of disease severity ordeath among 8807 COVID-19 patients in China: a meta-analysis. Diabetes Res. Clin. Pract. 166, 108346.
Guo, T., Fan, Y., Chen, M., Wu, X., Zhang, L., He, T., Wang, H., Wan, J., Wang,X., and Lu, Z. (2020b). Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 5, 811–818.
Gupta, R., Ghosh, A., Singh, A.K., and Misra, A. (2020). Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab. Syndr. 14, 211–212.
Haltmeier, T., Benjamin, E., Beale, E., Inaba, K., and Demetriades, D. (2016).Insulin-treated patients with diabetes mellitus undergoing emergency abdominalsurgery have worse outcomes than patients treated with oral agents. World J. Surg. 40, 1575–1582.
Henry, B.M., de Oliveira, M.H.S., Benoit, S., Plebani, M., and Lippi, G. (2020). Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin. Chem. Lab. Med. 58, 1021–1028.
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., et al. (2020a). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497–506.
Huang, W., Li, C., Wang, Z., Wang, H., Zhou, N., Jiang, J., Ni, L., Zhang, X.A., and Wang, D.W. (2020b). Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases. Sci. China Life Sci. 63, 1678–1687.
International Diabetes Federation (2019). IDF Diabetes Atlas, Ninth Edition (International Diabetes Federation).
Khwaja, A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin. Pract. 120, c179–c184.
Kosinski, C., Zanchi, A., and Wojtusciszyn, A. (2020). [Diabetes and COVID-19 infection]. Rev. Med. Suisse 16, 939–943.
Lee, K.J., and Carlin, J.B. (2010). Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. Am. J. Epidemiol. 171, 624–632.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Amjad Ali, Muhammad Abbas, Nowsherwan, Atta Muhammad Khan, Hussain Afridi, Sabir rehman, Wail Gul, Iftikhar Muhammad
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
