Diabetic Nephropathy, Obesity Increase COVID-19 Mortality Risk in Patients With Type 2 Diabetes

Patients with diabetic nephropathy or a combination of diabetes and obesity have a substantially higher risk of COVID-19 mortality, a study published in the Journal of Community Hospital Internal Medicine Perspectives reported recently.

Diabetic nephropathy—also called diabetic kidney disease—is a serious kidney-related complication of type 1 diabetes (T1D) and type 2 diabetes (T2D).

“Various conditions have been reported as predictors of an unfavorable outcome in COVID-19 patients,” the study authors said, adding that the “most severe cases seem to occur in the elderly or in patients with distinct comorbidities including cardiovascular disease or diabetes.”

Besides COVID-19, the authors noted that T2D is also a risk factor in patients infected with other viruses such as influenza, respiratory syncytial virus, SARS-coronavirus, and MERS-coronavirus.

According to the study, diabetic nephropathy and the combination of T2D and obesity had the highest COVID-19-related death rate of all studied risk factors at more than 70%. “Prominent laboratory findings were an impaired kidney function and lymphocytopenia, which were significantly pronounced in the group of diabetes patients with a poor outcome,” the authors said.

Researchers analyzed laboratory and radiologic findings from 75 hospitalized COVID-19 patients and their respective comorbidities at the Kliniken Hochfranken Munchberg, a German community hospital. All 75 patients showed COVID-19 symptoms, including fever, cough, and shortness of breath, and were hospitalized at some point between March 2020 and August 2020.

The mean age was 74.2 years (22–99 years), with 40 male and 35 female patients. Twenty-three patients did not survive (30.7%) and 11 patients were treated at the hospital’s intensive care unit (ICU), with 10 ICU patients requiring mechanical ventilation. The average age of patients who survived was 71 years while nonsurvivors were significantly older at 81.6 years (P < .0005); the death rate in male patients was higher than in female patients (37.5% vs 22.9%; P = .315).

In total, 26 patients with COVID-19 had T2D. Patients with T2D alone showed an increased death rate (46.2%), but patients with T2D and any diabetes-associated organ complication were at higher risk (57.9%). Specifically, patients with diabetic nephropathy had the highest percentage of non-survivors (73.3%, P = .0082), with obesity being the second highest risk factor (71.4%, P = .0155).

Patients with COVID-19 and congestive heart failure or chronic kidney disease also had an increased mortality risk, at 57.9% and 56%, respectively.

The study also showed that surviving patients with T2D required a significantly prolonged hospital treatment compared with patients without T2D (22.3 days vs 11 days; P = .0096).

Blood glucose was elevated in patients with T2D (P < .001), however there were no notable differences in blood glucose levels between surviving and non-surviving patients with T2D. Renal function was impaired in both surviving and non-surviving patients with T2D. Lymphocyte count and glomerular filtration rate were also notably impaired in non-surviving patients with COVID-19 and T2D.

“As an impact of blood glucose levels on radiologic findings in COVID-19 has been discussed previously, we analyzed and compared chest computed tomography (CT) images obtained from our patients,” the authors said. “We did not observe any striking differences comparing diabetes patients to the non-diabetes group.”

Reference

Schiller M, Solger K, Leipold S, Kerl HU, Kick W. Diabetes-associated nephropathy and obesity influence COVID-19 outcome in type 2 diabetes patients. J Community Hosp Intern Med Perspect. Published online September 20, 2021. doi:10.1080/20009666.2021.1957555