Temple University Hospital Philadelphia, Pennsylvania, United States
Disclosure(s):
Rashelle Ripa, MD: No financial relationships to disclose
Background: Diabetes mellitus is a well-established risk factor for severe COVID-19 outcomes, yet the combined impact of diabetes, obesity, and hyperglycemia on disease severity and mortality remains understudied. This study evaluated the prevalence of diabetes, clinical characteristics, and outcomes among hospitalized adults with COVID-19 in a large urban academic medical center.
Methods: A retrospective review was conducted of 478 adults between 18 and 100 years of age who were admitted with confirmed COVID-19 from March to May 2020. Data collected from the electronic medical record (EMR) via EPIC, included demographics, comorbidities, BMI, diabetes type, HbA1c, inflammatory markers, steroid use, need for ICU care, mechanical ventilation, hyperglycemia, and endocrinology consults. Statistical analyses included t-tests, chi-square tests, logistic regression for ICU admission, and Cox proportional hazards modeling for mortality.
Results: Among patients, 36% had preexisting diabetes, primarily type 2. Mortality occurred in 65 patients (13.6%) and was higher in those who were older (mean age 67.9 vs 53.8 years, p< 0.001), more likely to be Black (46% vs 38%, p=0.002), and had higher rates of diabetes (50.8% vs 33.9%, p< 0.001), hypertension (75.4% vs 52.5%, p< 0.001), hyperglycemia (50.8% vs 31.2%, p=0.002), and steroid-induced hyperglycemia (15.4% vs 6.1%, p=0.007. Higher HbA1c levels were observed in patients who developed cytokine storm (10.2% vs. 7.8%, p=0.01). Among patients who developed cytokine storm, 30.8% were deceased at the end of follow-up compared to 11.4% of those without cytokine storm (p < 0.001). ICU admission occurred in 32% of patients, with higher incidence among patients with diabetes (46.2% vs 34%, p=0.045), hyperglycemia (61.3% vs 26.5%, p< 0.0001), and steroid-induced hyperglycemia (21.5% vs 3.9%, p< 0.0001). Obesity (BMI ≥30 kg/m²) was present in 45%; paradoxically, higher BMI was associated with lower mortality, with mean BMI of 31 kg/m² in survivors versus 28.1 kg/m² in deceased patients (p=0.006).
Conclusions: In this urban center, diabetes, hyperglycemia, older age, Black race, and ICU-level care were strongly associated with higher COVID-19 mortality. Interestingly, higher BMI was linked to lower mortality, reflecting a potential obesity paradox though this finding may reflect selection bias or differences in clinical management. Further research is needed to clarify the mechanisms underlying this paradox and to guide management strategies for patients with obesity and diabetes during COVID-19 hospitalization.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
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