TY - JOUR
T1 - Associations of microvascular complications with all-cause death in patients with diabetes and COVID-19
T2 - The CORONADO, ABCD COVID-19 UK national audit and AMERICADO study groups
AU - for the CORONADO, the ABCD COVID-19 diabetes national audit and AMERICADO investigators
AU - Hadjadj, Samy
AU - Saulnier, Pierre Jean
AU - Ruan, Yue
AU - Zhu, Xu
AU - Pekmezaris, Renee
AU - Marre, Michel
AU - Halimi, Jean Michel
AU - Wargny, Matthieu
AU - Rea, Rustam
AU - Gourdy, Pierre
AU - Cariou, Bertrand
AU - Myers, Alyson K.
AU - Khunti, Kamlesh
N1 - Funding Information:
This study received funding from the following: the , supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly and the FFD—CORONADO initiative emergency grant; SFD—CORONADO initiative emergency grant; Air Liquide Health Care international. CORONADO initiative emergency grant; Allergan. CORONADO initiative emergency grant; AstraZeneca. CORONADO initiative emergency grant; Elivie. CORONADO initiative emergency grant; Fortil. CORONADO initiative emergency grant; Lifescan. CORONADO initiative emergency grant; CORONADO initiative emergency grant; Nantes Métropole. NHC. CORONADO initiative emergency grant; Novo Nordisk. CORONADO initiative emergency grant; Sanofi. CORONADO emergency grant; PHRC National COVID‐19 Hospitalization and Care Organization Division (DGOS) as part of the Hospital Clinical Research Program (PHRC COVID‐19‐20‐0138). All research facilities are acknowledged for providing research associates and research technicians for clinical investigations pro bono. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The ABCD Nationwide COVID‐19 & Diabetes is an independent audit which has received support from Public Health Wales and Novo Nordisk. Fondation Francophone de Recherche sur le Diabète
Funding Information:
The contributors to the different studies are listed in the supplementary material. With regard to the CORONADO initiative, we thank the sponsor (DRCI, Nantes University Hospital), the Clinical Project Manager (Maëva Saignes) and Assistant (Jeanne Saunier), the Clinical Research Associates (Selma El Andaloussi, Joëlle Martin-Gauthier, Emily Rebouilleau) and the Data Manager (Tanguy Roman). We thank the Communication Manager of l'Institut du Thorax (Vimla Mayoura). We acknowledge all medical staff involved in the diagnosis and treatment of patients with COVID-19 in participating centres. We thank all the GPs, specialists, pharmacists and biological laboratories in charge of hospitalized patients for providing additional medical information to our investigators. We thank the Société Francophone du Diabète (SFD) and Société Française d'Endocrinologie (SFE) for disseminating study design and organization, and the Fédération Française des Diabétiques (FFD) for participating in the organization of the study. We are grateful for the helpful critical appraisal of this manuscript from: Laurence Kessler (Strasbourg, France), Jean François Gautier (Paris Lariboisière, France), and Ronan Roussel (Paris Bichat, France, sadly deceased on January 30 2022). With regard to the ABCD COVID-19 national audit, we are grateful to all those who collected the data for this study, to Ben Maylor and Joanne Miksza for data template development, and to Melissa Cull of the ABCD secretariat for administrative support. Contributors to the ABCD COVID-19 national audit study are listed in the supplementary material. The ABCD Steering Group is acknowledged (names and corresponding institutions): Members: Jim Davies (4, 12), Benjamin C.T. Field (5, 6), Sophie Harris (10), Kamlesh Khunti (16), Dinesh Nagi, (1), Parth Narendran (7, 8), Rustam Rea and Yue Ruan (3, 4), Robert E.J. Ryder, (2), Kinga A. Várnai, (4, 11), Sarah H. Wild, (13), Emma G. Wilmot (14, 15). Institutions: 1, Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, UK; 2, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; 3, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK; 4, Oxford NIHR Biomedical Research Centre, UK; 5, Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK (ORCiD 0000-0002-1883-1588); 6, Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK; 7, Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 8, Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 9, Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, UK; 10, Diabetes and Endocrinology Department, King's College Hospital, UK; 11, Oxford University Hospitals NHS Foundation Trust, UK; 12, Department of Computer Science, University of Oxford; 13, Usher Institute, University of Edinburgh, Edinburgh, UK; 14, Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK; 15, University of Nottingham, Nottingham, UK; 16, University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital. This study received funding from the following: the Fondation Francophone de Recherche sur le Diabète, supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly and the FFD—CORONADO initiative emergency grant; SFD—CORONADO initiative emergency grant; Air Liquide Health Care international. CORONADO initiative emergency grant; Allergan. CORONADO initiative emergency grant; AstraZeneca. CORONADO initiative emergency grant; Elivie. CORONADO initiative emergency grant; Fortil. CORONADO initiative emergency grant; Lifescan. CORONADO initiative emergency grant; CORONADO initiative emergency grant; Nantes Métropole. NHC. CORONADO initiative emergency grant; Novo Nordisk. CORONADO initiative emergency grant; Sanofi. CORONADO emergency grant; PHRC National COVID-19 Hospitalization and Care Organization Division (DGOS) as part of the Hospital Clinical Research Program (PHRC COVID-19-20-0138). All research facilities are acknowledged for providing research associates and research technicians for clinical investigations pro bono. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The ABCD Nationwide COVID-19 & Diabetes is an independent audit which has received support from Public Health Wales and Novo Nordisk.
Funding Information:
This study received funding from the following: the , supported by Novo Nordisk, MSD, Abbott, AstraZeneca, Lilly and the —CORONADO initiative emergency grant; —CORONADO initiative emergency grant; Air Liquide Health Care international. CORONADO initiative emergency grant; Allergan. CORONADO initiative emergency grant; AstraZeneca. CORONADO initiative emergency grant; Elivie. CORONADO initiative emergency grant; Fortil. CORONADO initiative emergency grant; Lifescan. CORONADO initiative emergency grant; CORONADO initiative emergency grant; . NHC. CORONADO initiative emergency grant; Novo Nordisk. CORONADO initiative emergency grant; Sanofi. CORONADO emergency grant; PHRC National COVID‐19 Hospitalization and Care Organization Division (DGOS) as part of the Hospital Clinical Research Program (PHRC COVID‐19‐20‐0138). The ABCD Nationwide COVID‐19 & Diabetes is an independent audit which has received support from Public Health Wales and Novo Nordisk Fondation Francophone de Recherche sur le Diabète Fédération Française des Diabétiques Société Francophone du Diabète Nantes Métropole
Funding Information:
No potential conflicts of interest relevant to this article were reported. B. Cariou reports grants and personal fees from Amgen, Sanofi and Regeneron, and personal fees from Astra‐Zeneca, Akcea, Genfit, Gilead, Eli Lilly, Novo Nordisk and Merck (MSD). P. Gourdy reports personal fees from Abbott, Amgen, Astra‐Zeneca, Boehringer Ingelheim, Eli Lilly, MSD, Mundipharma, Sanofi and Servier, and grants and personal fees from Novo Nordisk. S. Hadjadj reports personal fees and non‐financial support from Astra Zeneca, MSD, Servier and Sanofi, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, Eli Lilly, Valbiotis and Novartis, grants from Dinno Santé and Pierre Fabre Santé, and non‐financial support from LVL. P. J. Saulnier reports personal fees from Astra Zeneca and non‐financial support from Abbott. M. Wargny reports personal fees from Novo Nordisk. R. Rea has acted as a consultant, speaker or received grants from Novo Nordisk, Eli Lilly and Boehringer Ingelheim. K. Khunti has acted as a consultant, speaker or received grants for investigator‐initiated studies for Astra Zeneca, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Berlin‐Chemie AG / Menarini Group, Janssen, and Napp. All other authors declare no competing interests.
Publisher Copyright:
© 2022 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
PY - 2023/1
Y1 - 2023/1
N2 - Aim: To provide a detailled analysis of the microvascular burden in patients with diabetes hopitalized for COVD-19. Materials and Methods: We analysed data from the French CORONADO initiative and the UK Association of British Clinical Diabetologists (ABCD) COVID-19 audit, two nationwide multicentre studies, and the AMERICADO, a multicentre study conducted in New York area. We assessed the association between risk of all-cause death during hospital stay and the following microvascular complications in patients with diabetes hospitalized for COVID-19: diabetic retinopathy and/or diabetic kidney disease and/or history of diabetic foot ulcer. Results: Among 2951 CORONADO, 3387 ABCD COVID-19 audit and 9327 AMERICADO participants, microvascular diabetic complications status was ascertained for 1314 (44.5%), 1809 (53.4%) and 7367 (79.0%) patients, respectively: 1010, 1059 and 1800, respectively, had ≥1 severe microvascular complication(s) and 304, 750 and 5567, respectively, were free of any complications. The patients with isolated diabetic kidney disease had an increased risk of all-cause death during hospital stay: odds ratio [OR] 2.53 (95% confidence interval [CI] 1.66-3.83), OR 1.24 (95% CI 1.00-1.56) and OR 1.66 (95% CI 1.40-1.95) in the CORONADO, the ABCD COVID-19 national audit and the AMERICADO studies, respectively. After adjustment for age, sex, hypertension and cardiovascular disease (CVD), compared to those without microvascular complications, patients with microvascular complications had an increased risk of all-cause death during hospital stay in the CORONADO, the ABCD COVID-19 diabetes national audit and the AMERICADO studies: adjusted OR (adjOR) 2.57 (95% CI 1.69-3.92), adjOR 1.22 (95% CI 1.00-1.52) and adjOR 1.33 (95% CI 1.15-1.53), respectively. In meta-analysis of the three studies, compared to patients free of complications, those with microvascular complications had an unadjusted OR for all-cause death during hospital stay of 2.05 (95% CI 1.42-2.97), which decreased to 1.62 (95% CI 1.19-2.119) after adjustment for age and sex, and to 1.50 (1.12-2.02) after hypertension and CVD were further added to the model. Conclusion: Microvascular burden is associated with an increased risk of death in patients hospitalized for COVID-19.
AB - Aim: To provide a detailled analysis of the microvascular burden in patients with diabetes hopitalized for COVD-19. Materials and Methods: We analysed data from the French CORONADO initiative and the UK Association of British Clinical Diabetologists (ABCD) COVID-19 audit, two nationwide multicentre studies, and the AMERICADO, a multicentre study conducted in New York area. We assessed the association between risk of all-cause death during hospital stay and the following microvascular complications in patients with diabetes hospitalized for COVID-19: diabetic retinopathy and/or diabetic kidney disease and/or history of diabetic foot ulcer. Results: Among 2951 CORONADO, 3387 ABCD COVID-19 audit and 9327 AMERICADO participants, microvascular diabetic complications status was ascertained for 1314 (44.5%), 1809 (53.4%) and 7367 (79.0%) patients, respectively: 1010, 1059 and 1800, respectively, had ≥1 severe microvascular complication(s) and 304, 750 and 5567, respectively, were free of any complications. The patients with isolated diabetic kidney disease had an increased risk of all-cause death during hospital stay: odds ratio [OR] 2.53 (95% confidence interval [CI] 1.66-3.83), OR 1.24 (95% CI 1.00-1.56) and OR 1.66 (95% CI 1.40-1.95) in the CORONADO, the ABCD COVID-19 national audit and the AMERICADO studies, respectively. After adjustment for age, sex, hypertension and cardiovascular disease (CVD), compared to those without microvascular complications, patients with microvascular complications had an increased risk of all-cause death during hospital stay in the CORONADO, the ABCD COVID-19 diabetes national audit and the AMERICADO studies: adjusted OR (adjOR) 2.57 (95% CI 1.69-3.92), adjOR 1.22 (95% CI 1.00-1.52) and adjOR 1.33 (95% CI 1.15-1.53), respectively. In meta-analysis of the three studies, compared to patients free of complications, those with microvascular complications had an unadjusted OR for all-cause death during hospital stay of 2.05 (95% CI 1.42-2.97), which decreased to 1.62 (95% CI 1.19-2.119) after adjustment for age and sex, and to 1.50 (1.12-2.02) after hypertension and CVD were further added to the model. Conclusion: Microvascular burden is associated with an increased risk of death in patients hospitalized for COVID-19.
KW - COVID-19
KW - chronic kidney disease
KW - diabetic foot
KW - microvascular complications
KW - mortality
KW - retinopathy
UR - http://www.scopus.com/inward/record.url?scp=85138095967&partnerID=8YFLogxK
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U2 - 10.1111/dom.14845
DO - 10.1111/dom.14845
M3 - Article
C2 - 36053971
AN - SCOPUS:85138095967
SN - 1462-8902
VL - 25
SP - 78
EP - 88
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 1
ER -
