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Original Research|Articles in Press

The association between diabetes and mortality among adult patients hospitalized with COVID-19: Cohort Study of Hospitalized Adults in Ontario, Canada and Copenhagen, Denmark

Published:February 22, 2023DOI:https://doi.org/10.1016/j.jcjd.2023.02.005
The association between diabetes and mortality among adult patients hospitalized with COVID-19: Cohort Study of Hospitalized Adults in Ontario, Canada and Copenhagen, Denmark
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      Abstract

      Importance

      Diabetes has been reported to be associated with an increased risk of death among patients with COVID-19. However, available studies lack detail on COVID illness severity and measurement of relevant comorbidities.

      Design, Setting, and Participants

      We conducted a multicenter, retrospective cohort study of patients over the age of 18 years who were hospitalized with COVID-19 between January 1, 2020 and November 30, 2020 in Ontario, Canada and Copenhagen, Denmark. Chart abstraction emphasizing co-morbidities and disease severity was performed by trained research personnel. The association between diabetes and death was measured using Poissson regression.

      Main Outcomes and Measures

      Within hospital 30-day risk of death.

      Results

      Our study included 1133 hospitalized patients with COVID-19 in Ontario and 305 in Denmark, of whom 405 and 75 patients respectively had pre-existing diabetes. In both Ontario and Denmark, patients with diabetes were more likely to be older, have chronic kidney disease, cardiovascular disease, higher troponin levels, and to receive antibiotics compared with adults who did not have diabetes. In Ontario, 24% (n=96) of adults with diabetes died compared with 15% (n=109) of adults without diabetes. In Denmark, 16% (n=12) of adults with diabetes died in hospital compared with 13% (n=29) among those without diabetes. In Ontario, the crude mortality rate ratio among patients with diabetes was 1.60 [1.24 – 2.07 95% CI] and in the adjusted regression model was 1.19 [0.86 – 1.66 95% CI]. In Denmark, the crude mortality rate ratio among patients with diabetes was 1.27 (0.68 – 2.36 95% CI) and in the adjusted model was 0.87 (0.49 – 1.54 95% CI)]. Meta-analysis of the two rate ratios from each region resulted in a crude mortality rate ratio of 1.55 (95% CI 1.22,1.96) and an adjusted mortality rate ratio of 1.11 (95% CI 0.84, 1.47).

      Conclusions

      Presence of diabetes was not strongly associated with in-hospital COVID mortality independent of illness severity and other comorbidities.

      Article info

      Publication history

      Accepted: February 17, 2023
      Received in revised form: February 9, 2023
      Received: July 13, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      KQ and MF were co-senior authors

      Study concept and design: All authors

      Acquisition of data: All authors

      Analysis/interpretation of data: All authors

      Drafting of the manuscript: Bogler O, Fralick M

      Critical revision of the manuscript: All authors

      Statistical analysis: All authors

      Obtained funding: This research is supported by Sinai Health Department of Medicine Research fund.

      Conflicts of interest: None

      Key Messages:

      •Diabetes has been a reported risk factor associated with experiencing a more severe course of COVID-19

      • However, this association between diabetes and adverse clinical outcomes has not been sufficiently characterized

      •After controlling for several confounders, diabetes was only weakly associated with 30-day risk of death in hospitalized patients

      Identification

      DOI: https://doi.org/10.1016/j.jcjd.2023.02.005

      Copyright

      © 2023 Canadian Diabetes Association.

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