Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul. (April 2021)

• Record Type: Journal Article
• Authors: Satman, Ilhan; Demirci, Ibrahim; Haymana, Cem; Tasci, Ilker; Salman, Serpil; Ata, Naim; Dagdelen, Selcuk; Sahin, Ibrahim; Emral, Rifat; Cakal, Erman; Atmaca, Aysegul; Sahin, Mustafa; Celik, Osman; Demir, Tevfik; Ertugrul, Derun; Unluturk, Ugur; Arga, Kazim Yalcin; Caglayan, Murat; Sonmez, Alper
• Is Part Of: Diabetes research and clinical practice. Volume 174(2021)
• Publication Date: 2021-04
• Subjects: COVID-19 -- Hospitalization -- Mortality -- Type 2 diabetes mellitus -- Istanbul; AHD Antihyperglycemic drugs -- ALT Alanine aminotransferase -- ASA Acetylsalicylic acid -- AST Aspartate aminotransferase -- BMI Body mass index -- CAD Coronary artery disease -- CI Confidence intervals -- CKD Chronic kidney disease -- CKD-EPI Chronic Kidney Disease Epidemiology Collaboration -- COPD Chronic obstructive pulmonary disease -- COVID-19 Coronavirus disease 2019 -- CRP C-reactive protein -- CT Computed tomography -- CVD Cardiovascular diseases (including coronary artery disease, peripheral artery disease, and stroke) -- eGFR Estimated glomerular filtration rate -- HbA1c Glycosylated hemoglobin A1c -- HDL-chol High density lipoprotein cholesterol -- ICD-10 International Classification of Diseases-10 -- ICU Intensive Care Unit -- IQR Interquartile range -- LDH Lactate dehydrogenase -- LDL-chol Low density lipoprotein cholesterol -- LMWH Low molecular weight heparin -- Lym Lymphocytes -- MoH Ministry of Health -- Non-DM Non diabetes mellitus -- OR Odds ratio -- PSM Propensity Score Matching system -- rt-PCR Reverse transcription-polymerase chain reaction -- SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 -- SPSS Statistical Package for the Social Sciences -- T2DM Type 2 diabetes mellitus -- ULN Upper limit of normal; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2021.108753
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Several studies have investigated the factors determining the clinical course of COVID-19. T2DM worsens the clinical course of COVID-19 and increases the risk of death. This retrospective population-based study covered all COVID-19 patients seen in Istanbul. Mortality was relatively low in general population and T2DM patients. Population dynamics and health system accessibility can reduce mortality rates. Abstract: Aims: Type 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul. Methods: A retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality. Results: Of the 93, 571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death. Conclusions: COVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population.