<a>OBJECTIVE</a>
<p>Diabetes mellitus may unfavorably influence the outcome of Coronavirus disease-19 (COVID-19), <a>but the determinants of this effect are still poorly
understood.</a></p>
<p><a>In this monocentric study we
aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma
glucose levels and </a>antidiabetic medications on the survival of COVID-19 patients.</p>
<p>RESEARCH DESIGN AND METHODS</p>
<p>This was a case series involving 387 COVID-19 patients
admitted to a single center in the region of Lombardy, the epicenter of the <a></a><a>Severe Acute Respiratory
Syndrome Coronavirus-2 </a>(SARS-CoV2)
pandemic in Italy, between February 20 and April
9, 2020.</p>
<p>Medical history, pharmacological treatments,
laboratory findings and clinical outcomes of non-diabetic and type 2 diabetic
patients were compared. Cox proportional hazards analysis was applied to
investigate risk factors associate with mortality.</p>
<p>RESULTS</p>
<p>Our samples included 90 patients (23.3%) with type 2
diabetes, who displayed double the mortality rate of non-diabetic subjects
(42.3% vs 21.7%, <i>P</i> < 0.001). <a>In spite of this, after correction for age and sex, risk of
mortality was significantly associated with a history of hypertension [adjusted
hazard ratio (aHR) 1.84, 95% confidence interval (C.I.) 1.15-2.95; <i>P </i>= 0.011), coronary artery disease (aHR
1.56, 95% C.I. 1.04-2.35; <i>P </i>= 0.031),
chronic kidney disease (aHR 2.07, 95% C.I. 1.27-3.38; <i>P </i>= 0.003), stroke (aHR 2.09, 95% C.I. 1.23-3.55; <i>P</i>=0.006) and cancer (aHR 1.57, 95% C.I.
1.08-2.42; <i>P </i>= 0.04), but not with
type 2 diabetes (<i>P </i>= 0.170). </a></p>
<p><a>In diabetic patients, elevated
plasma glucose </a>(<a>a</a>HR 1.22, 95%
C.I. 1.04 – 1.44 per mmol/l; <i>P </i>= 0.015) and IL-6 levels at admission [<a></a><a>aHR 2.47, 95% C.I.
1.28 – 4.78 per 1 standard deviation (SD) increase, <i>P </i>= 0.007</a>] as well as treatments with insulin
(aHR 3.05, 95% C.I. 1.57-5.95; <i>P </i>= 0.001)
and beta-blockers (aHR 3.20, 95% C.I. 1.50-6.60; <i>P </i>= 0.001) were independently
associated with an increased mortality, whereas the use of DPP-4 inhibitors was
significantly and independently associated with a lower risk of mortality (aHR
0.13, 95% C.I. 0.02 – 0.92, <i>P </i>= 0.042).</p>
<p>CONCLUSIONS</p>
<p><a></a><a>Plasma
glucose levels at admission and antidiabetic drugs may influence the survival
of COVID-19 patients affected by type-2 diabetes</a>.</p>
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