Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study
Since the spread of COVID-19, multiple studies have been conducted to understand the condition. A recent meta-analysis reported that diabetics affected with COVID-19 have doubled risk for ICU admission and a more than tripled risk for death. The author Bertrand Cariou and colleagues (2020) conducted a study titled, “Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study” published in the journal “Diabetologia” to study characteristics of COVID-19 affected diabetic hospitalized patients. Below is the summary of the article.
Objective:
To observe the phenotypic characteristics of the patients with diabetes hospitalized for COVID-19.
To estimate the prevalence of primary outcomes. To identify the prognostic factors that are associated with early severity of COVID-19.
Method:
Initially, the authors had decided to study the phenotype of patients admitted in the COVID-19 unit between 10 March and 10 April 2020. However, due to rapid recruitment, data was locked prematurely between the period of 10–31 March 2020.
The criteria for the recruitment of the patients were:
1. Hospitalization in the dedicated COVID-19 unit
2. Diagnosis of COVID-19 confirmed biologically and/or presence of ground-glass opacity and/or crazy paving on chest computed tomography [CT] scan.
3. History of diabetes or newly diagnosed on admission (i.e. HbA1c ≥48 mmol/ mol [6.5%] during hospitalization.
The primary endpoints were tracheal intubation for mechanical ventilation and death within 7 days of admission. Secondary outcomes include death, tracheal intubation, admission to ICU, discharged on 7 days of admission.
Results
During the duration of recruitment, 1317 participants with diabetes and confirmed COVID-19 admitted to 53 French hospitals. Out of this, 382 patients met with primary endpoints. The authors reported the severity of COVID-19 was independently associated with BMI. There was no independent association between COVID-19 severity and sex, long-term glucose control, chronic complications, hypertension, or usual medications, including RAAS blockers and DPP-4 inhibitors. Clinical characteristics of CORONADO patients were a high prevalence of fever and respiratory symptoms (cough, dyspnoea) and, to a lesser extent, digestive disorders. In diabetics, there was an increased requirement to manage acute metabolic disorders such as ketoacidosis, severe hyperglycemia, and hypoglycemia. 29.0% of CORONADO patients met with primary outcomes. BMI was positively and independently associated with primary outcomes. However, there was no association between BMI and death on day 7. Moreover, the risk of primary outcome was less pronounced in morbidly obese (grade 3 obesity). Also, the elderly population (>75 years) with long term diabetes and its complication were at risk of early death. On admission, prognostic factors such as dyspnoea, lymphopenia, and increased AST and CRP levels were independently associated with a severe course of COVID-19, especially in diabetics.
Limitations:
Limitations acknowledged by the authors are
1. Study was done on hospitalized COVID-19 cases and it cannot be generalized.
2. Sample size of the study population.
3. Short term prognosis was studied.