Diabetes can lead hospitalized Covid patients to death

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Unconscious and intubated Covid-19 patients are treated in Vila Penteado Hospital's ICU, in the Brasilandia neighborhood of Sao Paulo, on June 21, 2020. According ta a study published in June 21st, Brazil's public hospitals, like Vila Penteado, had almost 40% death rates from the new coronavirus, the double from private hospitals. Brasilandia is one of the neighborhhods in Sao Paulo with highest number of deaths from Covid-19 (Photo by Gustavo Basso/NurPhoto via Getty Images)

Diabetes is a big risk factor for a severe bout of coronavirus disease 2019 (Covid-19) and a new European study bears that out: It finds that one in every five hospitalized Covid-19 patients with diabetes die within 28 days of admission.

One US expert wasn’t surprised by that grim finding.

“Diabetic patients are clearly in a very high-risk category and should be among the first groups of people to get the vaccine,” advised Dr. Mangala Narasimhan, who directs critical care services at Northwell Health in New Hyde Park, New York.

She also advises people with diabetes to make sure they are taking control of their blood sugar levels and avoiding any complications of the disease.

Such steps “seem to really make a difference in terms of survival from COVID-19 infection,” said Narasimhan, who wasn’t involved in the new study.

The research was led by Bertrand Cariou and Samy Hadjadj, diabetologists at University Hospital Nantes in France.

In May of last year, they had released preliminary findings that showed that 10 percent of Covid-19 patients with diabetes died within seven days of hospital admission.

The newer, updated results are from a larger number of patients – close to 2,800 – treated for Covid-19 at 68 hospitals across France.

Their mean age was 70, nearly two-thirds were men, and many were overweight. About 40 percent were also experiencing various forms of complications from their diabetes.

During the 28 days after their admission to a hospital, 21 percent of patients died, the French team reported this week in the journal Diabetologia.

Of those patients who survived at least one month, 50 percent were discharged from the hospital with a median stay of nine days; 12 percent were still hospitalized at day 28, and 17 percent had been transferred from their first hospital to another facility.

Younger age, routine diabetes therapy using the drug metformin, and having had symptoms longer prior to hospital admission were key factors associated with a higher likelihood of being discharged from the hospital, the researchers said.

Patients who regularly took insulin – possibly indicating more advanced diabetes – had a 44-percent higher risk of death than those who didn’t take insulin, the investigators said.

A STRONG PREDICTOR OF DEATH

Long-term blood sugar control wasn’t associated with patient outcomes, but a higher level of blood sugar at the time of hospital admission was a strong predictor of death and of a lower chance of discharge.

Dr. Barbara Keber directs family medicine at Glen Cove Hospital in Glen Cove, New York. Reading over the findings, she said they show “diabetes is clearly a significant risk factor for both need for ICU/ventilator care in the hospital as well as for death” within a month of admission.

Keber said it “makes sense” that people with complications from poorly controlled diabetes are at higher risk, since this creates a “pro-inflammatory state” that is similar to that seen in advanced Covid-19.

But Keber also cautioned that death rates may have improved for Covid-19 patients, including those with diabetes, over the past year.

“This study was done in the first wave of the pandemic, and many of the current treatment regimens and medications that were tried in the early phase have been found to not be beneficial and other treatment regimens have taken their place,” she noted.

For example, “the current use of steroids for treatment may play a role in the [improved] prognosis of patients overall and especially for those with diabetes,” Keber said.

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