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Chume FC, Freitas PAC, Schiavenin LG, Sgarioni E, Leitao CB, Camargo JL. Glycated albumin in the detection of diabetes during COVID-19 hospitalization. PLoS One 2024; 19:e0297952. [PMID: 38498483 PMCID: PMC10947635 DOI: 10.1371/journal.pone.0297952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/14/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Diabetes has emerged as an important risk factor for COVID-19 adverse outcomes during hospitalization. We investigated whether the measurement of glycated albumin (GA) may be useful in detecting newly diagnosed diabetes during COVID-19 hospitalization. METHODS In this cross-sectional test accuracy study we evaluated HCPA Biobank data and samples from consecutive in-patients, from 30 March 2020 to 20 December 2020. ROC curves were used to analyse the performance of GA to detect newly diagnosed diabetes (patients without a previous diagnosis of diabetes and admission HbA1c ≥6.5%). RESULTS A total of 184 adults (age 58.6 ± 16.6years) were enrolled, including 31 with newly diagnosed diabetes. GA presented AUCs of 0.739 (95% CI 0.642-0.948) to detect newly diagnosed diabetes. The GA cut-offs of 19.0% was adequate to identify newly diagnosed diabetes with high specificity (85.0%) but low sensitivity (48.4%). CONCLUSIONS GA showed good performance to identify newly diagnosed diabetes and may be useful for identifying adults with the condition in COVID-19-related hospitalization.
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Affiliation(s)
- Fernando Chimela Chume
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Priscila Aparecida Correa Freitas
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Luisa Gazzi Schiavenin
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduarda Sgarioni
- Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane Bauermann Leitao
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Alves LI, Bosco AA, Rosa AA, Correia MRS, Matioli SR, da Silva MER. Diabetes related phenotypes and their influence on outcomes of patients with corona virus disease 2019 (COVID-19). Diabetol Metab Syndr 2023; 15:203. [PMID: 37845766 PMCID: PMC10577940 DOI: 10.1186/s13098-023-01168-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is associated with severe forms of COVID-19 but little is known about the diabetes-related phenotype considering pre-admission, on-admission and data covering the entire hospitalization period. METHODS We analyzed COVID-19 inpatients (n = 3327) aged 61.2(48.2-71.4) years attended from March to September 2020 in a public hospital. RESULTS DM group (n = 1218) differed from Non-DM group (n = 2109) by higher age, body mass index (BMI), systolic blood pressure and lower O2 saturation on admission. Gender, ethnicity and COVID-19-related symptoms were similar. Glucose and several markers of inflammation, tissue injury and organ dysfunction were higher among patients with diabetes: troponin, lactate dehydrogenase, creatine phosphokinase (CPK), C-reactive protein (CRP), lactate, brain natriuretic peptide, urea, creatinine, sodium, potassium but lower albumin levels. Hospital (12 × 11 days) and intensive care unit permanence (10 × 9 days) were similar but DM group needed more vasoactive, anticoagulant and anti-platelet drugs, oxygen therapy, endotracheal intubation and dialysis. Lethality was higher in patients with diabetes (39.3% × 30.7%) and increased with glucose levels and age, in male sex and with BMI < 30 kg/m2 in both groups (obesity paradox). It was lower with previous treatment with ACEi/BRA in both groups. Ethnicity and education level did not result in different outcomes between groups. Higher frequency of comorbidities (hypertension, cardiovascular/renal disease, stroke), of inflammatory (higher leucocyte number, RCP, LDH, troponin) and renal markers (urea, creatinine, potassium levels and lower sodium, magnesium) differentiated lethality risk between patients with and without diabetes. CONCLUSIONS Comorbidities, inflammatory markers and renal disfunction but not Covid-19-related symptoms, obesity, ethnicity and education level differentiated lethality risk between patients with and without diabetes.
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Affiliation(s)
- Lais Isidoro Alves
- Laboratório de Carboidratos e Radioimunoensaio LIM-18, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Aparecida Bosco
- Laboratório de Carboidratos e Radioimunoensaio LIM-18, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Aparecida Rosa
- Laboratório de Carboidratos e Radioimunoensaio LIM-18, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Regina Soares Correia
- Laboratório de Carboidratos e Radioimunoensaio LIM-18, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Russo Matioli
- Departamento de Genética e Biologia Evolutiva, Instituto de Biociências da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Elizabeth Rossi da Silva
- Laboratório de Carboidratos e Radioimunoensaio LIM-18, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Chen CX, Cabugao P, Nguyen M, Villegas D, Batra K, Singh A, Kioka M. Comparing demographics, clinical characteristics, and hospital outcomes by vaccine uptake status: A single-institution cross-sectional study. Medicine (Baltimore) 2023; 102:e35421. [PMID: 37800810 PMCID: PMC10553062 DOI: 10.1097/md.0000000000035421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Vaccination against Coronavirus disease 2019 (COVID-19) has been the cornerstone of reducing morbidity and mortality of this disease, as it has been shown to decrease the risk of viral transmission, severity of disease, hospitalization, and intubation. However, true understanding of its impact is skewed by heterogeneous vaccine administration due to lack of equitable access, vaccine hesitancy, and varying social determinants of health. Therefore, this study aims to identify groups that are less likely to be vaccinated and understand whether the resultant differences in vaccination rates affect morbidity and mortality in socially marginalized COVID-19 patients. A retrospective cohort analysis was performed on a randomized and stratified population of 939 COVID-19 patients from January 2021 to December 2021. Bivariate analysis and logistic regression were used to assess demographic and clinical characteristic trends in unvaccinated, partially vaccinated, and fully vaccinated groups. No one age (P = .21), gender (P = .9), race (P = .12), ethnicity (P = .09), or health insurance status (P = .13) group was more vaccinated than the other. Similarly, no subgroup was at increased odds of intubation (P = .08) or death. However, patients with all categories of comorbidities including cardiopulmonary disease (P = <.001, effect size .17), renal disease (P = <.001, effect size 0.138), metabolic disease (P = .04), and immunocompromised (P = .01) states were found to have significantly higher vaccination rates. Our study also shows that full vaccination protects against mortality and decreases the odds of intubation by 55% (adjusted odds ratio = 0.453, P value = .015) compared to no vaccination or partial vaccination. Findings from this study show an encouraging trend that sicker patients had higher rates of vaccination against COVID-19. This trend highlights the need for further identification of motivators that may be applied to vaccine-hesitant populations, which can help guide population-level policy, increase vaccination campaign yield, and reach for health equity.
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Affiliation(s)
- Claire Xinning Chen
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Paul Cabugao
- Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Max Nguyen
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Daniel Villegas
- Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Kavita Batra
- Office of Research, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
- Department of Medical Education and Office of Academic Affairs, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Aditi Singh
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Mutsumi Kioka
- Department of Pulmonary and Critical Care Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
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Schlesinger S, Lang A, Christodoulou N, Linnerz P, Pafili K, Kuss O, Herder C, Neuenschwander M, Barbaresko J, Roden M. Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis. Diabetologia 2023; 66:1395-1412. [PMID: 37204441 PMCID: PMC10198038 DOI: 10.1007/s00125-023-05928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/16/2023] [Indexed: 05/20/2023]
Abstract
AIMS/HYPOTHESIS To provide a systematic overview of the current body of evidence on high-risk phenotypes of diabetes associated with COVID-19 severity and death. METHODS This is the first update of our recently published living systematic review and meta-analysis. Observational studies investigating phenotypes in individuals with diabetes and confirmed SARS-CoV-2 infection with regard to COVID-19-related death and severity were included. The literature search was conducted from inception up to 14 February 2022 in PubMed, Epistemonikos, Web of Science and the COVID-19 Research Database and updated using PubMed alert to 1 December 2022. A random-effects meta-analysis was used to calculate summary relative risks (SRRs) with 95% CIs. The risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence using the GRADE approach. RESULTS A total of 169 articles (147 new studies) based on approximately 900,000 individuals were included. We conducted 177 meta-analyses (83 on COVID-19-related death and 94 on COVID-19 severity). Certainty of evidence was strengthened for associations between male sex, older age, blood glucose level at admission, chronic insulin use, chronic metformin use (inversely) and pre-existing comorbidities (CVD, chronic kidney disease, chronic obstructive pulmonary disease) and COVID-19-related death. New evidence with moderate to high certainty emerged for the association between obesity (SRR [95% CI] 1.18 [1.04, 1.34], n=21 studies), HbA1c (53-75 mmol/mol [7-9%]: 1.18 [1.06, 1.32], n=8), chronic glucagon-like peptide-1 receptor agonist use (0.83 [0.71, 0.97], n=9), pre-existing heart failure (1.33 [1.21, 1.47], n=14), pre-existing liver disease (1.40 [1.17, 1.67], n=6), the Charlson index (per 1 unit increase: 1.33 [1.13, 1.57], n=2), high levels of C-reactive protein (per 5 mg/l increase: 1.07 [1.02, 1.12], n=10), aspartate aminotransferase level (per 5 U/l increase: 1.28 [1.06, 1.54], n=5), eGFR (per 10 ml/min per 1.73 m2 increase: 0.80 [0.71, 0.90], n=6), lactate dehydrogenase level (per 10 U/l increase: 1.03 [1.01, 1.04], n=7) and lymphocyte count (per 1×109/l increase: 0.59 [0.40, 0.86], n=6) and COVID-19-related death. Similar associations were observed between risk phenotypes of diabetes and severity of COVID-19, with some new evidence on existing COVID-19 vaccination status (0.32 [0.26, 0.38], n=3), pre-existing hypertension (1.23 [1.14, 1.33], n=49), neuropathy and cancer, and high IL-6 levels. A limitation of this study is that the included studies are observational in nature and residual or unmeasured confounding cannot be ruled out. CONCLUSIONS/INTERPRETATION Individuals with a more severe course of diabetes and pre-existing comorbidities had a poorer prognosis of COVID-19 than individuals with a milder course of the disease. REGISTRATION PROSPERO registration no. CRD42020193692. PREVIOUS VERSION This is a living systematic review and meta-analysis. The previous version can be found at https://link.springer.com/article/10.1007/s00125-021-05458-8 FUNDING: The German Diabetes Center (DDZ) is funded by the German Federal Ministry of Health and the Ministry of Culture and Science of the State North Rhine-Westphalia. This study was supported in part by a grant from the German Federal Ministry of Education and Research to the German Center for Diabetes Research (DZD).
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Affiliation(s)
- Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany.
| | - Alexander Lang
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikoletta Christodoulou
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Linnerz
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kalliopi Pafili
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
| | - Janett Barbaresko
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Khunti K, Feldman EL, Laiteerapong N, Parker W, Routen A, Peek M. The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes. Diabetes Care 2023; 46:228-236. [PMID: 35944272 PMCID: PMC10090266 DOI: 10.2337/dc21-2495] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Eva L. Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - William Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Monica Peek
- Department of Medicine, University of Chicago, Chicago, IL
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Hadjadj S, Saulnier P, Ruan Y, Zhu X, Pekmezaris R, Marre M, Halimi JM, Wargny M, Rea R, Gourdy P, Cariou B, Myers AK, Khunti K. Associations of microvascular complications with all-cause death in patients with diabetes and COVID-19: The CORONADO, ABCD COVID-19 UK national audit and AMERICADO study groups. Diabetes Obes Metab 2023; 25:78-88. [PMID: 36053971 PMCID: PMC9538242 DOI: 10.1111/dom.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Abstract
AIM To provide a detailled analysis of the microvascular burden in patients with diabetes hopitalized for COVD-19. MATERIALS AND METHODS We analysed data from the French CORONADO initiative and the UK Association of British Clinical Diabetologists (ABCD) COVID-19 audit, two nationwide multicentre studies, and the AMERICADO, a multicentre study conducted in New York area. We assessed the association between risk of all-cause death during hospital stay and the following microvascular complications in patients with diabetes hospitalized for COVID-19: diabetic retinopathy and/or diabetic kidney disease and/or history of diabetic foot ulcer. RESULTS Among 2951 CORONADO, 3387 ABCD COVID-19 audit and 9327 AMERICADO participants, microvascular diabetic complications status was ascertained for 1314 (44.5%), 1809 (53.4%) and 7367 (79.0%) patients, respectively: 1010, 1059 and 1800, respectively, had ≥1 severe microvascular complication(s) and 304, 750 and 5567, respectively, were free of any complications. The patients with isolated diabetic kidney disease had an increased risk of all-cause death during hospital stay: odds ratio [OR] 2.53 (95% confidence interval [CI] 1.66-3.83), OR 1.24 (95% CI 1.00-1.56) and OR 1.66 (95% CI 1.40-1.95) in the CORONADO, the ABCD COVID-19 national audit and the AMERICADO studies, respectively. After adjustment for age, sex, hypertension and cardiovascular disease (CVD), compared to those without microvascular complications, patients with microvascular complications had an increased risk of all-cause death during hospital stay in the CORONADO, the ABCD COVID-19 diabetes national audit and the AMERICADO studies: adjusted OR (adj OR) 2.57 (95% CI 1.69-3.92), adj OR 1.22 (95% CI 1.00-1.52) and adj OR 1.33 (95% CI 1.15-1.53), respectively. In meta-analysis of the three studies, compared to patients free of complications, those with microvascular complications had an unadjusted OR for all-cause death during hospital stay of 2.05 (95% CI 1.42-2.97), which decreased to 1.62 (95% CI 1.19-2.119) after adjustment for age and sex, and to 1.50 (1.12-2.02) after hypertension and CVD were further added to the model. CONCLUSION Microvascular burden is associated with an increased risk of death in patients hospitalized for COVID-19.
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Affiliation(s)
- Samy Hadjadj
- Nantes UniversitéCHU Nantes, CNRS, Inserm, l'Institut du ThoraxNantesFrance
| | - Pierre‐Jean Saulnier
- Centre d'Investigation Clinique CIC 1402Université de Poitiers, Inserm, CHU de PoitiersPoitiersFrance
| | - Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
- Oxford NIHR Biomedical Research CentreOxfordUK
| | - Xu Zhu
- Institute of Health System ScienceFeinstein Institutes for Medical ResearchManhassetNew York
| | - Renee Pekmezaris
- Institute of Health System ScienceFeinstein Institutes for Medical ResearchManhassetNew York
| | - Michel Marre
- Clinique Ambroise Paré Neuilly‐sur‐Seine, Centre de Recherches des CordeliersUniversité Paris DiderotParisFrance
| | - Jean Michel Halimi
- CHU de Tours, Service Néphrologie, Dialyse et Transplantation, Tours, France & EA4245Tours UniversityToursFrance
| | - Matthieu Wargny
- Nantes UniversitéCHU Nantes, CNRS, Inserm, l'Institut du ThoraxNantesFrance
- Nantes Université, CHU Nantes, Pôle Hospitalo‐Universitaire 11: Santé Publique, Clinique des données, INSERMNantesFrance
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
- Oxford NIHR Biomedical Research CentreOxfordUK
| | - Pierre Gourdy
- CHU de Toulouse & UMR1297/I2MCUniversité de ToulouseToulouseFrance
| | - Bertrand Cariou
- Nantes UniversitéCHU Nantes, CNRS, Inserm, l'Institut du ThoraxNantesFrance
| | - Alyson K. Myers
- Department of Medicine, Division of EndocrinologyNorthwell HealthManhassetNew York
| | - Kamlesh Khunti
- University Hospitals of Leicester NHS TrustDiabetes Research Centre, Leicester General HospitalLeicesterUK
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Impact of Type 2 Diabetes Mellitus on the Incidence and Outcomes of COVID-19 Needing Hospital Admission According to Sex: Retrospective Cohort Study Using Hospital Discharge Data in Spain, Year 2020. J Clin Med 2022; 11:jcm11092654. [PMID: 35566794 PMCID: PMC9104185 DOI: 10.3390/jcm11092654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To analyze incidence and in-hospital mortality (IHM) of COVID-19 needing hospital admission in Spain (2020) in patients with T2DM. (2) Methods: We conducted a retrospective cohort study. Using the Spanish Register of Specialized Care-Basic Minimum Database we estimated age-adjusted incidence rates (IR). (3) Results: We included 203,488 patients (56.77% men), of whom 45,620 (22.41%) had T2DM. Age-adjusted IRs/1000 for men with and without T2DM was 12.90 and 5.87, respectively (IRR 2.20; 95% CI 2.18−2.22; p < 0.001), and for women with and without T2DM was 9.23 and 4.27, respectively (IRR 2.16; 95% CI 2.13−2.19; p < 0.001). Crude IHM was 23.86% in people with T2DM, and 15.94% in non-T2DM people (p < 0.001). After matching, intensive-care admission (7.37% vs. 6.15%; p < 0.001) and IHM (23.37% vs. 20.41%; p < 0.001) remained higher in women with T2DM. After matching, IHM among T2DM men was 1.5% higher than among non-T2DM men (24.27% vs. 22.72%; p < 0.001). Men with T2DM had a 34% higher IHM than women with T2DM. Prevalent T2DM increased IHM among women (1.09; 95% 1.03−1.16) and men (1.05; 95% 1.01−1.10). (4) Conclusions: Incidence rates of COVID-19 needing hospital admission were higher in men vs. women, and for people with T2DM vs. non-T2DM. Men had higher IHM beside T2DM status. Prevalent T2DM was associated with higher IHM for both sexes.
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Alhakak A, Butt JH, Gerds TA, Fosbøl EL, Mogensen UM, Krøll J, Pallisgaard JL, Gislason GH, Torp‐Pedersen C, Køber L, Weeke PE. Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality. Diabetes Obes Metab 2022; 24:499-510. [PMID: 34779086 PMCID: PMC8653248 DOI: 10.1111/dom.14604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022]
Abstract
AIM To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID-19 patients with and without diabetes. MATERIALS AND METHODS Danish nationwide registries were used to study the association between HbA1c levels and 30-day risk of all-cause mortality and the composite of severe COVID-19 infection, intensive care unit (ICU) admission and all-cause mortality. The study population comprised patients hospitalized with COVID-19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow-up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty-day standardized absolute risks and standardized absolute risk differences are reported. RESULTS We identified 3295 hospitalized COVID-19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference). CONCLUSIONS Patients with COVID-19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome.
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Affiliation(s)
| | - Jawad H. Butt
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Thomas A. Gerds
- Department of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
- The Danish Heart FoundationCopenhagenDenmark
| | - Emil L. Fosbøl
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Ulrik M. Mogensen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Johanna Krøll
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jannik L. Pallisgaard
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenHellerupDenmark
| | - Gunnar H. Gislason
- The Danish Heart FoundationCopenhagenDenmark
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenHellerupDenmark
- The National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Christian Torp‐Pedersen
- Department of Clinical Research and CardiologyNordsjællands HospitalHillerødDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Lars Køber
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Peter E. Weeke
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
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9
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Sayed Ahmed HA, Fouad AM, Elotla SF, Joudeh AI, Mostafa M, Shah A, Shah J, Mohamed SF. Prevalence and Associated Factors of Diabetes Distress, Depression and Anxiety Among Primary Care Patients With Type 2 Diabetes During the COVID-19 Pandemic in Egypt: A Cross-Sectional Study. Front Psychiatry 2022; 13:937973. [PMID: 35722556 PMCID: PMC9203894 DOI: 10.3389/fpsyt.2022.937973] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is growing worldwide. T2DM is often complicated by a range of psychological disorders that interfere with glycemic control and self-care. Previous studies have reported diabetes distress, depression, and anxiety among patients with T2DM; however; little is known about the burden of these comorbid mental disorders in primary care patients with T2DM treated in Egypt during the COVID-19 era. Participants were selected by convenient sampling from eight rural primary healthcare facilities from Ismailia in Egypt. Symptoms of diabetes distress, depression and anxiety were assessed by using the Arabic version of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9, and Generalized Anxiety Disorder Scales, respectively. Multiple hierarchical logistic regression models were used to estimate the significant factors associated with diabetes distress, depression, and anxiety. A total of 403 individuals with T2DM were interviewed. The prevalence of severe diabetes distress was 13.4% (95% CI: 10.1-16.7), while prevalence of depressive and anxiety symptoms was 9.2% (95% CI: 6.4-12.0%), and 4.0% (95% CI: 2.1-5.9), respectively. In a series of hierarchical logistic regression models, significant predictors for diabetes distress were being married, illiterate, not-working, living with insufficient income, and having multi-comorbidities. Likewise, the significant predictors for depression and anxiety were elevated glycated hemoglobin level and the higher PAID total score, while having multi-comorbidities was a significant predictor for anxiety only. Diabetes distress was more prevalent than depressive and anxiety symptoms in this study population. Several sociodemographic and clinical characteristics were identified to be related with psychological problems among patients with T2DM, which necessitate a multidisciplinary team-based approach for optimal screening and management.
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Affiliation(s)
- Hazem A Sayed Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Mahmoud Fouad
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sally Fawzy Elotla
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anwar I Joudeh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Mona Mostafa
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Asghar Shah
- Division of Biology and Medicine, Brown University, Providence, RI, United States
| | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Samar F Mohamed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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10
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Czupryniak L, Dicker D, Lehmann R, Prázný M, Schernthaner G. The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence? Cardiovasc Diabetol 2021; 20:198. [PMID: 34598700 PMCID: PMC8485772 DOI: 10.1186/s12933-021-01389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available—but currently limited—evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Centre, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger Lehmann
- Department of Endocrinology, Diabetes and Nutrition, University Hospital Zürich, Zürich, Switzerland
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, 1030, Vienna, Austria. .,Medical University of Vienna, Vienna, Austria.
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11
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Sonmez A, Demirci I, Haymana C, Tasci I, Dagdelen S, Salman S, Ata N, Sahin I, Emral R, Cakal E, Atmaca A, Sahin M, Celik O, Demir T, Ertugrul D, Unluturk U, Caglayan M, Satman I. Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes 2021; 13:585-595. [PMID: 33655669 PMCID: PMC8013711 DOI: 10.1111/1753-0407.13171] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been reported to be associated with a more severe course in patients with type 2 diabetes mellitus (T2DM). However, severe adverse outcomes are not recorded in all patients. In this study, we assessed disease outcomes in patients with and without T2DM hospitalized for COVID-19. METHODS A nationwide retrospective cohort of patients with T2DM hospitalized with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. Multivariate modeling was used to assess the independent predictors of demographic and clinical characteristics with mortality, length of hospital stay, and intensive care unit (ICU) admission and/or mechanical ventilation. RESULTS A total of 18 426 inpatients (median age [interquartile range, IQR]: 61 [17] years; males: 43.3%) were investigated. Patients with T2DM (n = 9213) were compared with a group without diabetes (n = 9213) that were matched using the propensity scores for age and gender. Compared with the group without T2DM, 30-day mortality following hospitalization was higher in patients with T2DM (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58-1.93; P < .001). The independent associates of mortality were older age, male gender, obesity, insulin treatment, low lymphocyte count, and pulmonary involvement on admission. Older age, low lymphocyte values, and pulmonary involvement at baseline were independently associated with longer hospital stay and/or ICU admission. CONCLUSIONS The current study from the Turkish national health care database showed that patients with T2DM hospitalized for COVID-19 are at increased risk of mortality, longer hospital stay, and ICU admission.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research HospitalAnkaraTurkey
| | - Ibrahim Demirci
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Training and Research HospitalAnkaraTurkey
| | - Cem Haymana
- Department of Endocrinology and MetabolismUniversity of Health Sciences Turkey, Gulhane Training and Research HospitalAnkaraTurkey
| | - Ilker Tasci
- Department of Internal MedicineUniversity of Health Sciences Turkey, Gulhane Faculty of Medicine and Gulhane Training and Research HospitalAnkaraTurkey
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | - Serpil Salman
- Department of Endocrinology and MetabolismMedica ClinicIstanbulTurkey
| | - Naim Ata
- Department of Strategy DevelopmentRepublic of Turkey, Ministry of HealthAnkaraTurkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Faculty of MedicineMalatya İnönü UniversityMalatyaTurkey
| | - Rifat Emral
- Department of Endocrinology and Metabolism, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Faculty of MedicineUniversity of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Faculty of MedicineSamsun 19 Mayis UniversitySamsunTurkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Osman Celik
- Public Hospitals General DirectorateRepublic of Turkey, Ministry of HealthAnkaraTurkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Faculty of MedicineDokuz Eylul UniversityAnkaraTurkey
| | - Derun Ertugrul
- Department of Endocrinology and Metabolism, Faculty of MedicineUniversity of Health Sciences Turkey, Kecioren Training and Research HospitalAnkaraTurkey
| | - Ugur Unluturk
- Department of Endocrinology and Metabolism, Faculty of MedicineHacettepe UniversityAnkaraTurkey
| | | | - Ilhan Satman
- Department of Endocrinology and Metabolism, Faculty of MedicineIstanbul UniversityIstanbulTurkey
- Turkish Institute of Public Health and Chronic DiseasesIstanbulTurkey
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12
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Sathish T, Chandrasekaran ND. Is prediabetes a risk factor for severe COVID-19? J Diabetes 2021; 13:521-522. [PMID: 33559395 PMCID: PMC8014723 DOI: 10.1111/1753-0407.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 01/17/2023] Open
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13
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Myers AK, Kim TS, Zhu X, Liu Y, Qiu M, Pekmezaris R. Predictors of mortality in a multiracial urban cohort of persons with type 2 diabetes and novel coronavirus 19. J Diabetes 2021; 13:430-438. [PMID: 33486896 PMCID: PMC8013168 DOI: 10.1111/1753-0407.13158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/09/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Diabetes has been identified as a risk factor for intubation and mortality in patients with coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We seek to examine the impact of clinical variables such as glycosylated hemoglobin (HbA1c) on mortality and need for intubation, as well as demographic variables such as age, sex, and race on persons with type 2 diabetes and COVID-19. METHODS Analyses were conducted on 4413 patients with an International Classification of Diseases and Related Health Problems (ICD-10) diagnosis of type 2 diabetes and COVID-19. Survival analysis was conducted using Kaplan-Meier curves and the log-rank test to compare subgroup analyses. RESULTS In this multivariate analysis, male gender, older age, and hyperglycemia at admission were associated with increased mortality and intubation, but this was not seen for race, ethnicity, insurance type, or HbA1c. Based on Kaplan-Meier analysis, having comorbid conditions such as hypertension, chronic kidney disease, and coronary artery disease was associated with a statistically significant increased risk of mortality. CONCLUSIONS Glycemic levels at admission have a greater impact on health outcomes than HbA1c. Older men and those with comorbid disease are also at greater risk for mortality. Further longitudinal studies need to be done to evaluate the impact of COVID-19 on type 2 diabetes.
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Affiliation(s)
- Alyson K. Myers
- Department of Internal Medicine, Division of EndocrinologyNorth Shore University HospitalManhassetNew YorkUSA
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
| | - Tara S. Kim
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Internal Medicine, Division of EndocrinologyLenox Hill HospitalNew YorkNew YorkUSA
| | - Xu Zhu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
- Division of Health Services Research, Department of MedicineCenter for Health Innovations and Outcomes ResearchManhassetNew YorkUSA
| | - Yan Liu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
| | - Michael Qiu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
- Division of Health Services Research, Department of MedicineCenter for Health Innovations and Outcomes ResearchManhassetNew YorkUSA
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