Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication
Clinical Characteristics and Outcomes of Patients With Diabetes and COVID-19 in Association With Glucose-Lowering Medication
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糖尿病和 COVID-19 患者与降糖药物相关的临床特征和结果
DOI：
10.2337/dc20-0660
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Huang, Kun
中科院分区：
文献类型：
--
作者：
Chen, Yuchen;Yang, Dong;Huang, Kun
目的 糖尿病是新冠病毒肺炎（COVID - 19）最显著的合并症之一。在此，我们描述了确诊或临床诊断为COVID - 19（肺部影像学有典型特征且有症状）的糖尿病患者的临床特征和结局，以及这些特征与降糖或降压药物的关联。
研究设计与方法 在这项涉及904例COVID - 19患者（136例患有糖尿病，多数为2型糖尿病）的回顾性研究中，收集了临床和实验室特征，并在糖尿病组和非糖尿病组以及服用不同药物的组之间进行了比较。采用逻辑回归分析探讨与死亡或不良预后相关的危险因素。
结果 在确诊和临床诊断的COVID - 19病例中，合并糖尿病的比例相似。糖尿病合并COVID - 19患者较高死亡率的危险因素为年龄较大（校正比值比[aOR]为每年增加1.09[95%置信区间1.04，1.15]；P = 0.001）和C - 反应蛋白升高（aOR为1.12[95%置信区间1.00，1.24]；P = 0.043）。胰岛素使用（aOR为3.58[95%置信区间1.37，9.35]；P = 0.009）与不良预后相关。在患有糖尿病和高血压的COVID - 19患者中，使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素II型1受体阻滞剂（ARB）的患者的临床结局与不使用ACEI/ARB的患者相当。
结论 C - 反应蛋白可能有助于识别住院期间死亡风险较高的糖尿病患者。老年糖尿病患者易发生与COVID - 19相关的死亡。需要关注使用胰岛素的糖尿病合并COVID - 19患者。ACEI/ARB的使用对患有糖尿病和高血压且感染COVID - 19的患者无显著影响。
OBJECTIVE Diabetes is one of the most distinct comorbidities of COVID-19. Here, we describe the clinical characteristics of and outcomes in patients with diabetes in whom COVID-19 was confirmed or clinically diagnosed (with typical features on lung imaging and symptoms) and their association with glucose-lowering or blood pressure-lowering medications. RESEARCH DESIGN AND METHODS In this retrospective study involving 904 patients with COVID-19 (136 with diabetes, mostly type 2 diabetes), clinical and laboratory characteristics were collected and compared between the group with diabetes and the group without diabetes, and between groups taking different medications. Logistic regression was used to explore risk factors associated with mortality or poor prognosis. RESULTS The proportion of comorbid diabetes is similar between cases of confirmed and of clinically diagnosed COVID-19. Risk factors for higher mortality of patients with diabetes and COVID-19 were older age (adjusted odds ratio [aOR] 1.09 [95% CI 1.04, 1.15] per year increase;P= 0.001) and elevated C-reactive protein (aOR 1.12 [95% CI 1.00, 1.24];P= 0.043). Insulin usage (aOR 3.58 [95% CI 1.37, 9.35];P= 0.009) was associated with poor prognosis. Clinical outcomes of those who use an ACE inhibitor (ACEI) or angiotensin II type-I receptor blocker (ARB) were comparable with those of patients who do not use ACEI/ARB among COVID-19 patients with diabetes and hypertension. CONCLUSIONS C-reactive protein may help to identify patients with diabetes who are at greater risk of dying during hospitalization. Older patients with diabetes were prone to death related to COVID-19. Attention needs to be paid to patients with diabetes and COVID-19 who use insulin. ACEI/ARB use showed no significant impact on patients with diabetes and hypertension who have COVID-19.