Mortality in patients with type 2 diabetes mellitus following coronavirus infection during the acute phase and long-term period

BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the major risk factors for severe COVID-19 and increased mortality. The long-term consequences of the infection remain unclear.

AIM: To assess mortality and risk factors for death in patients with T2DM after COVID-19, both in acute phase and long-term follow-up.

MATERIALS AND METHODS: This was a retrospective observational case-control study. Study included patients over 18 years of age with T2DM and recorded history of COVID-19 in clinical-epidemiological diabetes monitoring database from 2020 to 2022. Control group consisted of patients with T2DM who died between 2020 and 2022 from causes not related to COVID-19. Statistical analysis performed using RStudio 2024.04.02 (Posit Software, PBC) with R programming language, version 4.3.3.

RESULTS: The study included 7,625 patients with T2DM who had recovered from COVID-19 and 212,352 patients with T2DM without a documented history of COVID-19. From 2020 to 2022, the mortality rate in the post-COVID group was 24.6%, of which 21.7% occurred during the acute phase. This was significantly higher than in the control group (14.1%, p<0.001).

In the long-term period after COVID-19, the following factors were associated with increased mortality risk: older age (OR 1.06; 95% CI 1.04–1.07, p<0.001), longer diabetes duration (OR 1.03; 95% CI 1.01–1.05, p<0.05), and older age at diabetes onset (OR 1.04; 95% CI 1.02–1.05, p<0.001).

A lower risk of death in the long-term period was associated with the use of SGLT2 inhibitors (HR 0.45; 95% CI 0.29–0.70, p<0.001) and metformin (HR 0.40; 95% CI 0.30–0.54, p<0.001).

CONCLUSION: Mortality was higher among patients with history of COVID-19 compared to control group. Increase in mortality was primarily due to deaths in acute phase of infection. After adjusting for sex, age, following factors were independently associated with increased long-term mortality in T2DM patients after COVID-19: older age, male sex, insulin therapy. Protective factors included use of SGLT2 inhibitors and metformin.

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