Purpose: We describe the characteristics and prognosis of inpatients with diabetes and coronavirus disease 2019 (COVID-19) in Belgium.
Methods: We conducted a multicentre retrospective study during the first wave of the pandemic, from March 1, 2020 to May 6, 2020. Data on admission of patients with diabetes and hospitalized due to confirmed COVID-19 were collected. COVID-19 diagnosis was based on a positive polymerase chain reaction (PCR) test on nasopharyngeal swab and/or suggestive findings on computed tomography (CT) scan. Survivors were compared to non- survivors in order to identify prognostic risk factors for in-hospital death using multivariate analysis in both the total population and in the subgroup of patients admitted in the intensive care unit (ICU).
Results: The study included 375 patients. The median age was 73 [64-81] years and 93% had type 2 diabetes mellitus (T2DM). Median HbA1c was 7.1 [6.3-8] %. The prevalence of obesity was 49%. The mortality rate was 26.4% (99/375) in the total population and 40% (27/67) in ICU patients. Multivariate analysis identified older age (HR 1.049 [CI 1.03-1.07] per additional year of age, p<0.0001), male sex (HR 2.01 [1.31-3.07], p 0.0013) and C-reactive protein (CRP) elevation on admission (HR 1.00031 [1.0008-1.0054] for each 1 mg/L increase, p 0.0081) as independent risk factors for in-hospital death. Metformin (HR 0.51 [0.34-0.78], p 0.0018) and/or renin-angiotensin-aldosterone system (RAAS) blockers (HR 0.56 [0.36-0.86], p 0.0088) use before admission were independent protective factors.
Main conclusions: In-hospital mortality due to COVID-19 is high in patients with diabetes. We found in a well-phenotyped population that advanced age, male gender and elevated CRP on admission were independent risk factors for death in diabetic patients hospitalized due to COVID-19 in Belgium during the first wave of the pandemic. We also showed that metformin use before admission was associated with a significant reduction of COVID-19-related in- hospital mortality.