Insulin use in type II diabetic patients: a predictive of mortality in covid-19 infection

Marc Assaad; Nakisa Hekmat-Joo; Jeff Hosry; Ali Kassem; Ahmad Itani; Loai Dahabra; Ahmad Abou Yassine; Julie Zaidan; Dany El Sayegh

doi:10.1186/s13098-022-00857-2

Insulin use in type II diabetic patients: a predictive of mortality in covid-19 infection

Diabetol Metab Syndr. 2022 Jun 20;14(1):85. doi: 10.1186/s13098-022-00857-2.

Authors

Marc Assaad¹, Nakisa Hekmat-Joo², Jeff Hosry², Ali Kassem², Ahmad Itani³, Loai Dahabra², Ahmad Abou Yassine², Julie Zaidan⁴, Dany El Sayegh³

Affiliations

¹ Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, 10305, USA. massaad@northwell.edu.
² Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, 10305, USA.
³ Department of Pulmonary Disease and Critical Care, Staten Island University Hospital, Staten Island, NY, 10305, USA.
⁴ Department of Endocrinology, Staten Island University Hospital, Staten Island, NY, 10305, USA.

Abstract

Introduction: Starting December 2019, the world has been devastated by the rapid spread of coronavirus disease 2019 (Covid-19). Many risk factors have been associated with worse outcomes and death from Covid-19 pneumonia including having diabetes mellitus. To date, it is not clear if all group of diabetics share the same risk of complications with COVID-19 infection. This study aims to compare disease severity and mortality rate in insulin users versus non-insulin users.

Methods: In this retrospective case-control study conducted at the largest health care network in New York state, we included adult, diabetic patients admitted from March 2020 to October 2020 with Covid-19 pneumonia. We compared the baseline characteristics in addition to outcomes of diabetic patients on home insulin (cases) and non-insulin user diabetics (controls). In addition, to determine if home insulin use is associated with an increased mortality, we conducted a cox regression analysis.

Results: We included 696 patients in the study period with a median age of 57 years, interquartile range [IQR] 51-62, and median body mass index 29.9 (IQR: 26-34.7). The majority (476 [68%]) were males. We identified 227 cases (33%) and 469 controls (67%). More cases than controls were hypertensive (74% vs 67%, p = 0.03), on ACE/ARB (50% vs 42%, p = 0.05), and had a hemoglobin A1c > 8.1 (71% vs 44%, p < 0.001). More cases had AKI (52% vs 38%, p < 0.001), however no significant differences were found in intubation rates (26% vs 24%, p = 0.54), detection of pulmonary embolism (4% vs 6%, p = 0.19) or death rate (15% vs 11%, p = 0.22) comparing cases and controls. In a multivariate analysis, we found that home insulin use was independently associated with increased risk of death: Hazard ratio: 1.92, 95% confidence interval (1.13-3.23).

Conclusion: We showed herein that diabetic patients on home insulin with COVID-19 pneumonia, have worse outcomes and increased mortality compared to diabetics on oral antihyperglycemic agents. Close monitoring of insulin-dependent type II diabetic patients is needed in the current pandemic.

Keywords: Coronavirus; Covid-19; HbA1c; Inflammatory markers; Insulin; Insulin Resistance; Invasive ventilation; Mechanical ventilation; SARS-CoV-2; Type II Diabetes mellitus.