The presence of macrovascular complications in people with diabetes is associated with a worse prognosis in hospitalized patients with COVID-19

Patients with diabetes and previous macrovascular complications (coronary artery disease, cerebrovascular disease, or peripheral arterial disease) admitted for COVID-19 to a hospital have a worse prognosis and twice the mortality compared to the general population. This is described by an international study in which European research groups from France, the United Kingdom and Spain participate, led by the Diabetes and Associated Metabolic Diseases area of CIBER (CIBERDEM), the Research Group on Endocrinology, Diabetes and Nutrition of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau, and the Endocrinology Service of the Hospital del Mar and which publishes the journal Cardiovascular Diabetology.

Diabetes, a risk factor

The COVID-19 pandemic has had a negative impact on people with diabetes. It is considered that diabetes poses a greater risk of presenting more serious forms of infection by the SARS-CoV2 virus, being associated with a higher rate of complications and mortality. However, the impact of having chronic complications associated with diabetes on the prognosis of COVID-19 was unknown to date.

Toward this end, this multicenter retrospective study collected cases from several cohorts and analyzed data from a total of 4,106 adults with preexisting diabetes hospitalized for COVID-19 infection in the United Kingdom, France, and Spain during the early phase of the pandemic. (between March 2020 and October 2020). Of these patients, a total of 1,652 (40.2%) had some previous macrovascular disease, with a death rate of 28.5%.

“This work is the first to demonstrate that the presence of macrovascular complications in patients with diabetes who are admitted for COVID-19 implies a worse prognosis and double the risk of mortality”, explains Dídac Mauricio, head of the CIBERDEM group at the IIB Sant Pau and coordinator of the study. “A subsequent analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors to these adverse results”, adds Gemma Llauradó, also a researcher in the study, assistant to the Endocrinology and Nutrition Service at the Hospital del Mar, researcher at IMIM-Hospital del Mar and CIBERDEM.

Along with these findings, the work has also shown that these patients had a lower proportion of ICU admissions and need for mechanical ventilation, possibly associated with selective admission criteria at this stage of the pandemic.

“Our findings in this research highlight the importance of correctly assessing the prognosis of these patients, as well as performing intensive follow-up in this high-risk subgroup. In addition, these results highlight the need to design specific public health programs aimed at preventing SARS-CoV2 infection in this population, which include for example, among other measures, strengthening vaccination campaigns”, the researchers conclude.

This research has been led by the head of the CIBERDEM group, Dídac Mauricio (Hospital de la Santa Creu i Sant Pau), in close collaboration with researcher Gemma Llauradó (Hospital del Mar), belonging to the CIBERDEM group led by Joan Vendrell. The publication of this work is the result of the collaboration between researchers from 3 European countries, England (Association of British Clinical Diabetologist – ABCD Diabetes), France (CORONAvirus SARS-CoV2 & Diabetes Outcomes -CORONADO- Study) and Spain (Hospital del Mar, Hospital de la Santa Creu i Sant Pau and HM Hospitals).

Reference article

Llauradó G, Vlacho B, Wargny M, Ruan Y, Franch-Nadal J, Domingo P, Gourdy P, Saulnier PJ, Hadjadj S, Wild SH, Rea R, Cariou B, Khunti K, Mauricio D; CORONADO, the ABCD COVID-19 diabetes national audit, HM Hospitales investigators and the Hospital del Mar – Hospital de la Santa Creu i Sant Pau Diabetes Research Group. The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19). Cardiovasc Diabetol. 2022 Oct 19;21(1):216. doi: 10.1186/s12933-022-01657-8.