Prevalence of Diabetics Among Patients with COVID-19 and the Impact of DM on the Course of Infection

Source Data

Data were obtained from 12 studies involving 2108 Chinese patients with confirmed COVID-19 and supplemented with fresh data from the university hospital in Padua (i.e., from the epicenter of the outbreak in Italy) as of 19 March 2020, where 146 patients were hospitalized with COVID-19 on that date.

Prevalence of Diabetes in Patients with COVID-19

The average age of Chinese patients was 49.6 years, and the prevalence of diabetes among them was 10.3%. The overall prevalence of diabetes in China is 10.9%, and in the age group 40–59 years, 12.3% of the population has diabetes.

At the Italian facility in Padua, the average age of infected patients was 65.3 years, and 8.9% of them had pre-existing diabetes. The prevalence of diabetes in this Italian region is 6.2%, and in the age group 55–75 years, it is 11.0%.

Severity of COVID-19 in Diabetics

Of the 12 analyzed Chinese studies, 6 evaluated the severity of COVID-19 depending on the presence of diabetes. They included 1687 patients. The combined incidence of diabetes was 2.26 times higher in patients with an unfavorable course of infection compared to patients with a favorable course of the infection.

As of 17 March, the average age of 2003 Italian patients who died from COVID-19 was 80.5 years (interquartile range 31–103 years), and 70% of them were men. Information on comorbidities was available for 355 patients. The detected prevalence of diabetes was 35.5%. In 2018, the prevalence of diabetes in Italy in the same age and gender distribution group was 20.3%. The incidence of diabetes was thus 1.75 times higher in patients who died from COVID-19 than in the general population.

DPP-4 Inhibitors and a Potential for Protection?

Dipeptidyl peptidase 4 (DPP-4) is an enzyme responsible for the degradation of glucagon-like peptide 1 (GLP-1). Its inhibition is used in the treatment of type 2 diabetes. The coronavirus that caused MERS (Middle-East Respiratory Syndrome) utilizes DPP-4 for anchoring on the surface of human cells. The SARS-CoV2 virus primarily uses the ACE2 enzyme for this purpose. Nevertheless, it would be interesting to assess whether DPP-4 inhibitors used in the treatment of diabetes could to some extent provide protection against COVID-19 caused by SARS-CoV-2.

Conclusion

The authors conclude their work by stating that diabetes may not increase the risk of SARS-CoV-2 infection but may worsen the course and impact of the COVID-19 disease caused by this new coronavirus. These findings are consistent with existing knowledge about the association between diabetes and increased mortality from both acute and chronic diseases, including infections. However, the insights are rapidly evolving with new incoming data.

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Source: Fadini G. P., Morieri M. L., Longato E., Avogaro A Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest 2020 Mar 28, doi: 10.1007/s40618-020-01236-2 [Epub ahead of print].