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Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative

Bertrand Cariou 1, 2 Matthieu Wargny 1, 2, 3, 4 Anne-Sophie Boureau 1, 2 Sarra Smati 1, 2 Blandine Tramunt 5, 6 Rachel Desailloud 7, 8 Maylis Lebeault 9 Coralie Amadou 10, 11 Deborah Ancelle 12 Beverley Balkau 13 Lyse Bordier 14 Sophie Borot 15 Muriel Bourgeon 16, 11 Olivier Bourron 17, 18, 19 Emmanuel Cosson 20, 21, 22, 23 Martin Eisinger 24, 25 Céline Gonfroy-Leymarie 26 Jean-Baptiste Julla 27, 18 Lucien Marchand 28 Laurent Meyer 29 Dominique Seret-Bégué 30 Dominique Simon 17 Ariane Sultan 31, 32 Charles Thivolet 33, 34, 35 Anne Vambergue 36 Camille Vatier 37, 38, 39 Patrice Winiszewski 40 Pierre-Jean Saulnier 41, 42 Bernard Bauduceau 14 Pierre Gourdy 5, 6 Samy Hadjadj 1, 2 
Abstract : Aims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital.Conclusions/interpretation: Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status.Trial registration: ClinicalTrials.gov NCT04324736.
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Submitted on : Thursday, June 16, 2022 - 10:09:09 AM
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Bertrand Cariou, Matthieu Wargny, Anne-Sophie Boureau, Sarra Smati, Blandine Tramunt, et al.. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative. Diabetologia, Springer Verlag, In press, ⟨10.1007/s00125-022-05734-1⟩. ⟨hal-03696563⟩

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