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Smati S, Tramunt B, Wargny M, Caussy C, Gaborit B, Vatier C, Vergès B, Ancelle D, Amadou C, Bachir LA, Bourron O, Coffin‐Boutreux C, Barraud S, Dorange A, Fremy B, Gautier J, Germain N, Larger E, Laugier‐Robiolle S, Meyer L, Monier A, Moura I, Potier L, Sabbah N, Seret‐Bégué D, Winiszewski P, Pichelin M, Saulnier P, Hadjadj S, Cariou B, Gourdy P. Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study. Diabetes Obes Metab 2021; 23:391-403. [PMID: 33051976 PMCID: PMC7675375 DOI: 10.1111/dom.14228] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
AIM To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D). METHODS From the CORONAvirus-SARS-CoV-2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19-related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status. RESULTS Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2 , reference group), 726 (36.9%) overweight (25-29.9 kg/m2 ) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2 ) and 314 (16.0%) with class II/III obesity (≥35 kg/m2 ). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years. CONCLUSIONS Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.
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Affiliation(s)
- Sarra Smati
- Département d'EndocrinologieDiabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU NantesNantesFrance
| | - Blandine Tramunt
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPSUniversité de ToulouseToulouseFrance
| | | | - Cyrielle Caussy
- University of Lyon, CarMen Laboratory, INSERM, INRA, INSA LyonUniversité Claude Bernard Lyon 1Pierre‐BéniteFrance
- Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon SudHospices Civils de LyonPierre‐BéniteFrance
| | - Bénédicte Gaborit
- Département d'Endocrinologie et de DiabétologieHôpital Nord, Assistance Publique Hôpitaux de MarseilleMarseilleFrance
| | - Camille Vatier
- APHP, Hôpital Saint‐AntoineReference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Département d'EndocrinologieParisFrance
- Sorbonne UniversitéINSERM UMRS 938, Centre de Recherche Saint‐AntoineParisFrance
| | - Bruno Vergès
- Endocrinologie, DiabétologieCHU Dijon, Hôpital du BocageDijonFrance
| | - Deborah Ancelle
- Service de Diabétologie EndocrinologieCentre Hospitalier MonodLe HavreFrance
| | - Coralie Amadou
- Département de DiabétologieCentre Hospitalier Sud FrancilienCorbeil EssonneFrance
| | - Leila A. Bachir
- Département de DiabétologieHôpital Franco‐BritanniqueLevallois PerretFrance
| | - Olivier Bourron
- Sorbonne UniversitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière‐Charles Foix, INSERM, Centre de Recherche des CordeliersParisFrance
- Institute of Cardiometabolism and NutritionParisFrance
| | | | - Sara Barraud
- Département de DiabétologieCHU de ReimsReimsFrance
| | - Anne Dorange
- Département de DiabétologieEndocrinologie, Nutrition, CH Le MansLe MansFrance
| | | | - Jean‐François Gautier
- Département de Diabétologie et EndocrinologieHôpital Lariboisière, APHPParisFrance
- INSERM UMRS 1138Université́ Paris Diderot‐Paris VII, Sorbonne Paris CitéParisFrance
| | - Natacha Germain
- Service Endocrinologie CHU de Saint‐Etienne et Laboratoire TAPESaint‐EtienneFrance
| | - Etienne Larger
- Service de DiabétologieHôpital Cochin, APHP, Université de ParisParisFrance
| | | | - Laurent Meyer
- Département d'EndocrinologieDiabétologie et Nutrition, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Arnaud Monier
- Département d'EndocrinologieDiabétologie, Nutrition, Centre Hospitalier Louis PasteurChartresFrance
| | - Isabelle Moura
- Unité Transversale de DiabétologieEndocrinologie, Nutrition, Centre Hospitalier d'AlbiAlbiFrance
| | - Louis Potier
- Département d'EndocrinologieDiabétologie et Nutrition, Hôpital Bichat, Assistance Publique‐Hôpitaux de Paris, Centre de Recherche des Cordeliers, INSERM, U‐1138, Université de ParisParisFrance
| | - Nadia Sabbah
- Département d'Endocrinologie et Maladies Métaboliques, André Rosemon, Hôpital de CayenneUniversité des Antilles et de la Guyane FrançaisePointe à PitreFrance
- EA3593, Amazon Ecosystems and Tropical DiseasesUniversité de GuyaneGuyane FrançaiseFrance
| | | | | | - Matthieu Pichelin
- Département d'EndocrinologieDiabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU NantesNantesFrance
| | - Pierre‐Jean Saulnier
- Centre d'Investigation Clinique CIC 1402Université de Poitiers, INSERM, CHU de PoitiersPoitiersFrance
| | - Samy Hadjadj
- Département d'EndocrinologieDiabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU NantesNantesFrance
| | - Bertrand Cariou
- Département d'EndocrinologieDiabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU NantesNantesFrance
| | - Pierre Gourdy
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPSUniversité de ToulouseToulouseFrance
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Cariou B, Hadjadj S, Wargny M, Pichelin M, Al-Salameh A, Allix I, Amadou C, Arnault G, Baudoux F, Bauduceau B, Borot S, Bourgeon-Ghittori M, Bourron O, Boutoille D, Cazenave-Roblot F, Chaumeil C, Cosson E, Coudol S, Darmon P, Disse E, Ducet-Boiffard A, Gaborit B, Joubert M, Kerlan V, Laviolle B, Marchand L, Meyer L, Potier L, Prevost G, Riveline JP, Robert R, Saulnier PJ, Sultan A, Thébaut JF, Thivolet C, Tramunt B, Vatier C, Roussel R, Gautier JF, Gourdy P. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia 2020; 63:1500-1515. [PMID: 32472191 PMCID: PMC7256180 DOI: 10.1007/s00125-020-05180-x] [Citation(s) in RCA: 524] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Coronavirus disease-2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Diabetes has rapidly emerged as a major comorbidity for COVID-19 severity. However, the phenotypic characteristics of diabetes in COVID-19 patients are unknown. METHODS We conducted a nationwide multicentre observational study in people with diabetes hospitalised for COVID-19 in 53 French centres in the period 10-31 March 2020. The primary outcome combined tracheal intubation for mechanical ventilation and/or death within 7 days of admission. Age- and sex-adjusted multivariable logistic regressions were performed to assess the prognostic value of clinical and biological features with the endpoint. ORs are reported for a 1 SD increase after standardisation. RESULTS The current analysis focused on 1317 participants: 64.9% men, mean age 69.8 ± 13.0 years, median BMI 28.4 (25th-75th percentile: 25.0-32.7) kg/m2; with a predominance of type 2 diabetes (88.5%). Microvascular and macrovascular diabetic complications were found in 46.8% and 40.8% of cases, respectively. The primary outcome was encountered in 29.0% (95% CI 26.6, 31.5) of participants, while 10.6% (9.0, 12.4) died and 18.0% (16.0, 20.2) were discharged on day 7. In univariate analysis, characteristics prior to admission significantly associated with the primary outcome were sex, BMI and previous treatment with renin-angiotensin-aldosterone system (RAAS) blockers, but not age, type of diabetes, HbA1c, diabetic complications or glucose-lowering therapies. In multivariable analyses with covariates prior to admission, only BMI remained positively associated with the primary outcome (OR 1.28 [1.10, 1.47]). On admission, dyspnoea (OR 2.10 [1.31, 3.35]), as well as lymphocyte count (OR 0.67 [0.50, 0.88]), C-reactive protein (OR 1.93 [1.43, 2.59]) and AST (OR 2.23 [1.70, 2.93]) levels were independent predictors of the primary outcome. Finally, age (OR 2.48 [1.74, 3.53]), treated obstructive sleep apnoea (OR 2.80 [1.46, 5.38]), and microvascular (OR 2.14 [1.16, 3.94]) and macrovascular complications (OR 2.54 [1.44, 4.50]) were independently associated with the risk of death on day 7. CONCLUSIONS/INTERPRETATIONS In people with diabetes hospitalised for COVID-19, BMI, but not long-term glucose control, was positively and independently associated with tracheal intubation and/or death within 7 days. TRIAL REGISTRATION clinicaltrials.gov NCT04324736.
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Affiliation(s)
- Bertrand Cariou
- Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093, Nantes Cedex 01, France.
| | - Samy Hadjadj
- Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093, Nantes Cedex 01, France.
| | - Matthieu Wargny
- Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093, Nantes Cedex 01, France
- CIC-EC 1413, Clinique des Données, CHU Nantes, Nantes, France
| | - Matthieu Pichelin
- Département d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Hôpital Guillaume et René Laennec, 44093, Nantes Cedex 01, France
| | - Abdallah Al-Salameh
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Amiens, PeriToxUMR_I 01, Université de Picardie, Amiens, France
| | - Ingrid Allix
- Département d'Endocrinologie, Diabétologie, Nutrition, CHU de Angers, Angers, France
| | - Coralie Amadou
- Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Gwénaëlle Arnault
- Département d'Endocrinologie, Diabétologie et Maladies Métaboliques, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Florence Baudoux
- Clinique d'Endocrinologique Marc-Linquette, Hôpital Claude-Huriez, CHRU de Lille, Lille, France
| | - Bernard Bauduceau
- Département de Diabétologie, H.I.A. Begin, Saint Mandé, France
- Fondation Francophone pour la Recherche sur le Diabète (FFRD), Paris, France
| | - Sophie Borot
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU de Besançon, Besançon, France
| | - Muriel Bourgeon-Ghittori
- Département d'Endocrinologie, Diabétologie et Nutrition, Assistance Publique Hôpitaux de Paris, Université Paris Saclay, Hôpital Antoine Béclère, Clamart, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Olivier Bourron
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - David Boutoille
- Département des Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France
| | - France Cazenave-Roblot
- Département des Maladies Infectieuses et Tropicales, CHU de Poitiers, INSERM U1070, Poitiers, France
- Société de Pathologie Infectieuse de langue Française (SPILF), Paris, France
| | | | - Emmanuel Cosson
- Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Département d'Endocrinologie, Diabétologie et Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Université Paris 13, Sorbonne Paris Cité, UMR U557 Inserm / U11125 INRAE / CNAM / Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Sandrine Coudol
- CIC-EC 1413, Clinique des Données, CHU Nantes, Nantes, France
| | - Patrice Darmon
- Département d'Endocrinologie et de Diabétologie, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Emmanuel Disse
- Département d'Endocrinologie, Diabétologie et Nutrition, Hospices Civils de Lyon, CarMeN Laboratory, Inserm 1060, Lyon, France, Université Claude Bernard Lyon 1, Lyon, France
| | - Amélie Ducet-Boiffard
- Département d'Endocrinologie et de Diabétologie, Centre Hospitalier Départemental de Vendée, La Roche sur Yon, France
| | - Bénédicte Gaborit
- Département d'Endocrinologie et de Diabétologie, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | | | - Véronique Kerlan
- Département d'Endocrinologie, CHU de Brest, EA 3878 GETBO, Brest, France
| | - Bruno Laviolle
- Université de Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Lucien Marchand
- Département d'Endocrinologie et de Diabétologie, Centre Hospitalier St. Joseph - St. Luc, Lyon, France
| | - Laurent Meyer
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Louis Potier
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France
| | - Gaëtan Prevost
- Département d'Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Rouen, Université de Rouen, Rouen, France
| | - Jean-Pierre Riveline
- Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
- Paris Diderot-Paris VII Université, Paris, France
- Inserm UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - René Robert
- Université de Poitiers, CIC Inserm 1402, Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Pierre-Jean Saulnier
- Centre d'Investigation Clinique CIC 1402, Université de Poitiers, Inserm, CHU de Poitiers, Poitiers, France
| | - Ariane Sultan
- Département d'Endocrinologie, Diabète, Nutrition et CIC Inserm 1411, CHU de Montpellier, Montpellier, France
| | | | - Charles Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, Université Claude Bernard Lyon 1, Lyon, France
- Société Francophone du Diabète (SFD), Paris, France
| | - Blandine Tramunt
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, Toulouse, France
| | - Camille Vatier
- Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France
- Sorbonne University, Inserm UMRS 938, Saint-Antoine Research Center, Paris, France
| | - Ronan Roussel
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Recherche des Cordeliers, Inserm, U-1138, Université de Paris, Paris, France
| | - Jean-François Gautier
- Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Pierre Gourdy
- Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, Toulouse, France
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