Clinical Characteristics and Outcomes of COVID-19 patients with diabetes mellitus in Kuwait

  1. Abdullah Alshukry
  2. Mohammad Bu Abbas
  3. Yaseen Ali
  4. Barrak Alahmad
  5. Abdullah A. Al-Shammari
  6. Ghadeer Alhamar
  7. Mohammad Abu-Farha
  8. Jehad AbuBaker
  9. Sriraman Devarajan
  10. Ali A. Dashti
  11. Fahd Al-Mulla
  12. Hamad Ali

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Abstract

Background

COVID-19 has a highly variable clinical presentation, ranging from asymptomatic to severe respiratory symptoms and death. Diabetes seems to be one of the main comorbidities contributing to a worse COVID-19 outcome.

Objective

In here we analyze the clinical characteristics and outcomes of diabetic COVID-19 patients Kuwait.

Methods

In this single-center, retrospective study of 417 consecutive COVID-19 patients, we analyze and compare disease severity, outcome, associated complications, and clinical laboratory findings between diabetic and non-diabetic COVID-19 patients.

Results

COVID-19 patients with diabetes had more ICU admission than non-diabetic COVID-19 patients (20.1% vs. 16.8%, p<0.001). Diabetic COVID-19 patients also recorded higher mortality in comparison to non-diabetic COVID-19 patients (16.7% vs. 12.1%, p<0.001). Diabetic COVID-19 patients had significantly higher prevalence of comorbidities, such as hypertension. Laboratory investigations also highlighted notably higher levels of C-reactive protein in diabetic COVID019 patients and lower estimated glomerular filtration rate. They also showed a higher incidence of complications. logistic regression analysis showed that every 1 mmol/L increase in fasting blood glucose in COVID-19 patients is associated with 1.52 (95% CI: 1.34 – 1.72, p<0.001) times the odds of dying from COVID-19.

Conclusion

Diabetes is a major contributor to worsening outcomes in COVID-19 patients. Understanding the pathophysiology underlining these findings could provide insight into better management and improved outcome of such cases.

Highlights of the Study

  • A significantly higher proportion of COVID-19 patients with diabetes mellitus required admission to the ICU.

  • Higher fasting blood glucose was associated with higher risk of COVID-19 associated mortality.

  • COVID-19 patients with diabetes mellitus had significantly higher incidence of complications including sepsis, ARDS, cardiac failure and renal failure.

Article activity feed

  1. Version published to 10.1101/2020.08.20.20178525v3 on medRxiv
  2. Version published to 10.1016/j.heliyon.2021.e06706
  3. ScreenIT

    SciScore for 10.1101/2020.08.20.20178525: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 2.1 Study design: The Standing Committee for Coordination of Health and Medical Research at the Ministry of Health in Kuwait reviewed and approved this retrospective study (Institutional Review Board 2020/1404).
    Consent: The Standing Committee waived the requirement for written informed consent because of the urgency of data collection and the exceptional nature of the disease.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using GraphPad Prism software (La Jolla, CA, USA), SPSS (Statistical Package for Social Sciences) for Windows version 25.0 (IBM SPSS Inc., Chicago, IL, USA) and R version 3.4.3 (R Foundation for Statistical Computing, Vienna, Austria).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One of the major limitations of this study was the lack of BMI cohort data. Adiposity could be a strong predictor in such settings.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2020.08.20.20178525v2 on medRxiv
  5. Version published to 10.1101/2020.08.20.20178525v1 on medRxiv