Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients With Diabetes Hospitalized With COVID-19

Milosavljevic et al., Journal of Community Hospital Internal Medicine Perspectives, doi:10.55729/2000-9666.1127, Nov 2022

Source

PDF

All
Studies

Meta
Analysis

https://c19early.org/milosavljevic.html

Metformin for COVID-19

3rd treatment shown to reduce risk in July 2020, now with p < 0.00000000001 from 105 studies.

Lower risk for mortality, ventilation, ICU, hospitalization, progression, and recovery.

No treatment is 100% effective. Protocols combine treatments.

5,800+ studies for 172 treatments. c19early.org

Retrospective 733 hospitalized COVID-19 patients with diabetes in the USA, showing lower risk of severity with metformin use.

Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.

Important missing comments or errors? Let us know.

risk of severe case, 33.0% lower, OR 0.67, p = 0.03, treatment 377, control 356, RR approximated with OR.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

1. c19early.org, c19early.org/soc/usa.html.c19early.org/soc/usa.html.

Milosavljevic et al., 9 Nov 2022, retrospective, USA, peer-reviewed, mean age 67.4, 7 authors, study period 1 March, 2020 - 31 December, 2020. Contact: jovmilosa@gmail.com.

This Paper Metformin All

Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients With Diabetes Hospitalized With COVID-19

Jovan Milosavljevic, Navya Reddy Perkit, Sakshi Jhawar, Melbin Thomas, Justin Ling, Samuel Amankwah, Asha Mary Thomas

Journal of Community Hospital Internal Medicine Perspectives, doi:10.55729/2000-9666.1127

Objectives: To identify risk factors for severe disease and death among patients with diabetes and coronavirus disease 2019 (COVID-19) infection. Methods: This retrospective cohort study conducted at three hospitals included 733 consecutive patients with DM admitted with confirmed COVID-19 (March 1 -December 31, 2020). Multivariable logistic regression was performed to identify predictors of severe disease and death. Results: The mean age was 67.4 ± 14.3 years, 46.9% were males and 61.5% were African American. Among all patients, 116 (15.8%) died in the hospital. A total of 317 (43.2%) patients developed severe disease, 183 (25%) were admitted to an ICU and 118 (16.1%) required invasive mechanical ventilation. Increasing BMI (OR, 1.13; 95% CI, 1.02e1.25), history of chronic lung disease (OR, 1.49; 95% CI, 1.05e2.10) and increasing time since the last HbA1c test (OR, 1.25; 95% CI, 1.05e1.49) were the preadmission factors associated with increased odds of severe disease. Preadmission use of metformin (OR, 0.67; 95% CI, 0.47e0.95) or GLP-1 agonists (OR, 0.49; 95% CI, 0.27e0.87) was associated with decreased odds of severe disease. Increasing age (OR, 1.21; 95% CI, 1.09e1.34), co-existing chronic kidney disease greater than stage 3 (OR, 3.38; 95% CI, 1.67e6.84), ICU admission (OR, 2.93; 95% CI, 1.28e6.69) and use of invasive mechanical ventilation (OR, 8.67, 95% CI, 3.88e19.39) were independently associated with greater odds of in-hospital death. Conclusion: Several clinical characteristics were identified to be predictive of severe disease and in-hospital death among patients with underlying diabetes hospitalized with COVID-19.

Author contributions J.M.: data collection, data analysis, writing e original draft; N.P.: data collection, writing e original draft; M.T., S.J., J.L. and S.A.: data collection, writing e review & editing; A.T.: conceptualization, supervision, writing -review & editing. All authors read and approved the final manuscript. Conflict of interest The authors declare that they have no competing or conflicts of interests.

References

Agarwal, Schechter, Southern, Crandall, Tomer, Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019, Diabetes Care, doi:10.2337/dc20-1543

Aleem, Samad, Slenker, Emerging variants of SARS-CoV-2 and novel therapeutics against coronavirus (COVID-19)

Apicella, Campopiano, Mantuano, Mazoni, Coppelli et al., COVID-19 in people with diabetes: understanding the reasons for worse outcomes, Lancet Diabetes Endocrinol, doi:10.1016/S2213-8587(20)30238-2

Bai, Lian, Li, Zhang, Qiao, The active GLP-1 analogue liraglutide alleviates H9N2 influenza virus-induced acute lung injury in mice, Microb Pathog, doi:10.1016/j.micpath.2020.104645

Bello-Chavolla, Bahena, Opez, Ne, Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico, J Clin Endocrinol Metab, doi:10.1210/clinem/dgaa346

Bode, Garrett, Messler, Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States, J Diabetes Sci Technol, doi:10.1177/1932296820924469

Buuren S Van, Groothuis-Oudshoorn, Mice: multivariate imputation by chained equations in R, J Stat Software, doi:10.18637/jss.v045.i03

Cariou, Hadjadj, Wargny, Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study, Diabetologia, doi:10.1007/s00125-020-05180-x

Dong, Du, Gardner, An interactive web-based dashboard to track COVID-19 in real time, Lancet Infect Dis, doi:10.1016/S1473-3099(20)30120-1

Hariyanto, Intan, Hananto, Putri, Kurniawan, Pre-admission glucagon-like peptide-1 receptor agonist (GLP-1RA) and mortality from coronavirus disease 2019 (Covid-19): a systematic review, meta-analysis, and metaregression, Diabetes Res Clin Pract, doi:10.1016/j.diabres.2021.109031

Izcovich, Ragusa, Tortosa, Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review, PLoS One, doi:10.1371/journal.pone.0241955

Klonoff, Messler, Umpierrez, Association between achieving inpatient glycemic control and clinical outcomes in hospitalized patients with COVID-19: a multicenter, retrospective hospital-based analysis, Diabetes Care, doi:10.2337/dc20-1857

Kristan, Kim, Nelson, Predictors of severe COVID-19 in patients with diabetes: a multicenter review, Endocr Pract, doi:10.1016/j.eprac.2021.05.011

Leung, Niikura, Yang, Sin, COVID-19 and COPD, Eur Respir J, doi:10.1183/13993003.02108-2020

Liu, Zhang, Wang, Hyperglycemia is a strong predictor of poor prognosis in COVID-19, Diabetes Res Clin Pract, doi:10.1016/j.diabres.2020.108338

Marshall, Murthy, Diaz, A minimal common outcome measure set for COVID-19 clinical research, Lancet Infect Dis, doi:10.1016/S1473-3099(20)30483-7

Mehta, Kohn, Koliwad, Rushakoff, Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes, BMJ Open Diabetes Res Care, doi:10.1136/bmjdrc-2021-002203

Mesas, Cavero-Redondo, Alvarez-Bueno, Predictors of in-hospital COVID-19 mortality: a comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions, PLoS One, doi:10.1371/journal.pone.0241742

Peters, Dixon, The effect of obesity on lung function, Expet Rev Respir Med, doi:10.1080/17476348.2018.1506331

Rosenthal, Cao, Gundrum, Sianis, Safo, Risk factors associated with in-hospital mortality in a US national sample of patients with COVID-19, JAMA Netw Open, doi:10.1001/jamanetworkopen.2020.29058

Wood, White, Royston, How should variable selection be performed with multiply imputed data?, Stat Med, doi:10.1002/sim.3177

Xian, Liu, Nilsson, Metformin inhibition of mitochondrial ATP and DNA synthesis abrogates NLRP3 inflammasome activation and pulmonary inflammation, Immunity, doi:10.1016/j.immuni.2021.05.004

Yan, Yang, Wang, Clinical characteristics and outcomes of patients with severe covid-19 with diabetes, BMJ Open Diabetes Research and Care, doi:10.1136/bmjdrc-2020-001343

Yang, Sun, Zhang, Zhang, The effect of metformin on mortality and severity in COVID-19 patients with diabetes mellitus, Diabetes Res Clin Pract, doi:10.1016/j.diabres.2021.108977

Zhu, She, Cheng, Association of blood glucose control and outcomes in patients with COVID-19 and preexisting type 2 diabetes, Cell Metabol, doi:10.1016/j.cmet.2020.04.021

Zou, Hastie, Regularization and variable selection via the elastic net, J Roy Stat Soc B, doi:10.1111/j.1467-9868.2005.00503.x

DOI record: { "DOI": "10.55729/2000-9666.1127", "ISSN": [ "2000-9666" ], "URL": "http://dx.doi.org/10.55729/2000-9666.1127", "author": [ { "affiliation": [], "family": "Milosavljevic", "given": "Jovan", "sequence": "first" }, { "affiliation": [], "family": "Perkit", "given": "Navya Reddy", "sequence": "additional" }, { "affiliation": [], "family": "Jhawar", "given": "Sakshi", "sequence": "additional" }, { "affiliation": [], "family": "Thomas", "given": "Melbin", "sequence": "additional" }, { "affiliation": [], "family": "Ling", "given": "Justin", "sequence": "additional" }, { "affiliation": [], "family": "Amankwah", "given": "Samuel", "sequence": "additional" }, { "affiliation": [], "family": "Thomas", "given": "Asha Mary", "sequence": "additional" } ], "container-title": "Journal of Community Hospital Internal Medicine Perspectives", "container-title-short": "Journal of Community Hospital Internal Medicine Perspectives", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2022, 11, 10 ] ], "date-time": "2022-11-10T09:23:01Z", "timestamp": 1668072181000 }, "deposited": { "date-parts": [ [ 2022, 11, 10 ] ], "date-time": "2022-11-10T09:23:01Z", "timestamp": 1668072181000 }, "indexed": { "date-parts": [ [ 2022, 11, 11 ] ], "date-time": "2022-11-11T06:03:57Z", "timestamp": 1668146637113 }, "is-referenced-by-count": 0, "issue": "6", "issued": { "date-parts": [ [ 2022, 11, 9 ] ] }, "journal-issue": { "issue": "6", "published-online": { "date-parts": [ [ 2022, 11, 9 ] ] } }, "language": "en", "member": "34701", "original-title": [], "page": "27-34", "prefix": "10.55729", "published": { "date-parts": [ [ 2022, 11, 9 ] ] }, "published-online": { "date-parts": [ [ 2022, 11, 9 ] ] }, "publisher": "Greater Baltimore Medical Center", "reference-count": 0, "references-count": 0, "relation": {}, "resource": { "primary": { "URL": "https://scholarlycommons.gbmc.org/jchimp/vol12/iss6/5" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Internal Medicine" ], "subtitle": [], "title": "Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients With Diabetes Hospitalized With COVID-19", "type": "journal-article", "volume": "12" }

Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.

Submit

Post

@CovidAnalysis

FAQ

Public domain CC0 1.0