High Prevalence of Diabetes Among Hospitalized COVID-19 Minority Patients: Data from a Single Tertiary Hospital

Authors

Hassan Ashktorab, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA. hashktorab@howard.edu.
Gholamreza Oskrochi, College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait.
Suryanarayana Reddy Challa, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Lakshmi G. Chirumamilla, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Faezeh Ahangarzadeh, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Boubini Jones-Wonni, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Nader Shayegh, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Mudasir Rashid, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Zainab Naqvi, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Elizabeth Ekpe, GI Division, Department of Medicine, Cancer Center, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, D.C., 20060, USA.
Sen Sabyasachi, Department of Medicine (Endocrinology) and Biochemistry & Molecular Medicine, The George Washington University, and Associate Chief Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA.
Anteneh Zenabe, Endocrinology Division, Department of Medicine, Howard University College of Medicine, Washington, DC, USA.
Hassan Brim, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

7-27-2023

Journal

Journal of racial and ethnic health disparities

DOI

10.1007/s40615-023-01714-2

Keywords

African Americans; Covid; Diabetes

Abstract

BACKGROUND AND AIM: Type 2 diabetes mellitus (DM) is a common comorbidity in the minority population and is associated with poor outcomes in COVID-19 patients. We hypothesized that COVID-19 patients with pre-existing diabetes mellitus are prone to fatal outcomes compared to non-diabetic patients. We aimed to illustrate the characteristics and outcomes and identify the risk factors for in-hospital mortality of COVID-19 patients with DM. METHODS: In this single-center retrospective study, electronic medical records of hospitalized patients with confirmed COVID-19 diagnosis at Howard University Hospital (HUH) from March 2020 to Dec 2021 were analyzed. Clinical, demographic, and serological information, as well as outcomes, were recorded and analyzed. RESULTS: Among 463 COVID-19 patients, 66.3% (n = 307) were African Americans (AA) and 35.9% (n = 166) had diabetes, with a mean age of 64 years. The majority of the diabetic patients were AA (n = 123, 74.1%) and had a higher mortality rate (n = 26, 74.3%) compared to others. Length of stay in the hospital is significantly more for the diabetic than for the non-diabetic patients (11.3 vs. 8.3 days, p = 0.03). A higher proportion of ICU admission (32.3% vs. 17.9%, p =  < 0.001), intubation (17% vs. 11.7%, p = 0.04), and increased mortality (21.1% vs. 12.2%, p = 0.01) were identified in COVID-19 patients with DM than in those with no DM. Among DM patients, non-survivors were older (69.9 vs. 62.9 years). DM patients were more likely to have underlying hypertension (72.3% vs. 43.3%, p =  < 0.001), obesity (44.8% vs. 32.1%, p = 0.007), chronic kidney disease (23.6 vs. 11.8%, p = 0.001), and cardiovascular disease (29.5% vs. 14.3%, p = 0.001) than the non-DM patients. HbA1C above 9%, indicating poorly controlled hyperglycemia, was associated with poor outcome among the DM subjects. AST (23.5% vs. 31.3%) and creatinine (61.4% vs. 37.9%) were significantly more elevated in DM COVID-19 patients (all p-values < 0.05). The levels of serum troponin (42.5% vs. 30.9%, p = 0.03), interleukin-6 (67.2 vs. 50%, p = 0.04), ferritin (65.6% vs. 44.6%, p = 0.03), procalcitonin (58.1% vs. 46.1, p = 0.03), and D-dimers (92.8% vs. 86.5%, p = 0.04) were significantly higher in DM patients as compared to those in non-DM COVID-19 patients, indicating more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm. CONCLUSION: The prevalence of DM is high among hospitalized COVID-19 patients in our cohort. While DM patients have a higher mortality rate and ICU admission than non-DM patients, other factors such as underlying comorbidities, old age, elevated creatinine, AST, serum inflammatory markers, and D-dimer are more significant predictors of fatal outcomes. DM patients had higher metabolic derangements, hypercoagulability, and severe inflammatory response. No significant difference of outcome was noted between DM patients of different races in our cohort. In the diabetic group, it appears that race may not significantly contribute to the observed mortality disparity. This could be attributed to the significant influence of diabetes, which acts as a major effector, potentially overshadowing the significance of race in this context.

APA Citation

Ashktorab, Hassan; Oskrochi, Gholamreza; Challa, Suryanarayana Reddy; Chirumamilla, Lakshmi G.; Ahangarzadeh, Faezeh; Jones-Wonni, Boubini; Shayegh, Nader; Rashid, Mudasir; Naqvi, Zainab; Ekpe, Elizabeth; Sabyasachi, Sen; Zenabe, Anteneh; and Brim, Hassan, "High Prevalence of Diabetes Among Hospitalized COVID-19 Minority Patients: Data from a Single Tertiary Hospital" (2023). GW Authored Works. Paper 3016.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3016

Department

Medicine