Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United States
Ando et al.,
Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United..,
Scientific Reports, doi:10.1038/s41598-021-96720-x
Retrospective 28,093 COVID+ patients in the USA, showing lower risk of hospitalization with metformin use.
risk of hospitalization, 39.0% lower, HR 0.61, p = 0.04, treatment 19 of 663 (2.9%), control 1,056 of 27,430 (3.8%), adjusted per study, multivariable, Cox proportional hazards.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Ando et al., 9 Sep 2021, retrospective, USA, peer-reviewed, 6 authors, study period 1 January, 2020 - 30 November, 2020.
Abstract: www.nature.com/scientificreports
OPEN
Impact of overlapping risks
of type 2 diabetes and obesity
on coronavirus disease severity
in the United States
Wataru Ando1,5*, Takeshi Horii2,5, Takayuki Uematsu3, Hideaki Hanaki4, Koichiro Atsuda2 &
Katsuya Otori1
The impact of overlapping risk factors on coronavirus disease (COVID-19) severity is unclear. To
evaluate the impact of type 2 diabetes (T2D) and obesity on COVID-19 severity, we conducted a
cohort study with 28,095 anonymized COVID-19 patients using data from the COVID-19 Research
Database from January 1, 2020 to November 30, 2020. The mean age was 50.8 ± 17.5 years, and
11,802 (42%) patients were male. Data on age, race, sex, T2D complications, antidiabetic medication
prescription, and body mass index ≥ 30 kg/m2 (obesity) were analysed using Cox proportional hazard
models, with hospitalization risk and critical care within 30 days of COVID-19 diagnosis as the
main outcomes. The risk scores were 0–4 for age ≥ 65 years, male sex, T2D, and obesity. Among the
participants, 11,294 (61.9%) had obesity, and 4445 (15.8%) had T2D. T2D, obesity, and male sex were
significantly associated with COVID-19 hospitalization risk. Regarding hospitalization risk scores,
compared with those for hospitalization risk score 0 and critical care risk score 0, hazard ratios [95%
confidence intervals] were 19.034 [10.470–34.600] and 55.803 [12.761–244.015] (P < 0.001) (P < 0.001),
respectively, for risk score 4. Complications from diabetes and obesity increased hospitalization and
critical care risks for COVID-19 patients.
Coronavirus disease (COVID-19) is currently one of the most concerning infections globally1. It has a high
incidence and mortality rate in the United States2. The risk of increasing COVID-19 severity has been reported,
with men having a 2.76-fold higher risk of hospitalization owing to COVID-19 than women. According to Grasselli et al.3, 82% of patients admitted to intensive care units (ICUs) were men. Obesity was reported to increase
the risk of COVID-19, ICU admission, and death by 1.46-, 2.13-, and 1.74-fold, respectively, suggesting that
obesity may affect lung function and immune function4. Furthermore, the greatest risk of severe COVID-19 is
age1. Additionally, statistical analyses by the Center for Disease Control reported an increase in COVID-19 risk
with an increase in age; compared with the 18–29-year-old group, the 85-year-old group had a 13- and 630-fold
increase in hospitalization and mortality risks, respectively. Therefore, patient characteristics, such as male sex,
obesity, and advanced age, can be risk factors for severe d
isease5. Studies reported that COVID-19 comorbidities, including hypertension, chronic heart disease, lung d
isease6, and type 2 diabetes (T2D), remarkably affected
disease severity7.
T2D is a serious social problem in the United States8 because the number of newly diagnosed patients with
T2D increased by 75% for all age groups between 1988 and 2 0109. Moreover, less than half of all American adults
do not follow the recommended guidelines for diabetes care10, and obese men aged > 60 years are more likely to
develop T2D11,12. Therefore, risk factors for T2D are considered similar to those for severe COVID-19. Although
several reports exist on the risk of severe COVID-19, studies on severe COVID-19 owing to overlapping risk
1
Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of
Pharmacy,..
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