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By Ernie Mundell and Robert Preidt HealthDay Reporters

THURSDAY, Feb. 18, 2021 (HealthDay News) -- Diabetes is a big risk factor for a severe bout of COVID-19, and a new European study bears that out: It finds that 1 in every 5 hospitalized COVID-19 patients with diabetes die within 28 days of admission.

One U.S. expert wasn't surprised by that grim finding.

"Diabetic patients are clearly in a very high-risk category and should be among the first groups of people to get the vaccine," advised Dr. Mangala Narasimhan, who directs critical care services at Northwell Health in New Hyde Park, N.Y. She also advises people with diabetes to make sure they are taking control of their blood sugar levels and avoiding any complications of the disease.

Such steps "seem to really make a difference in terms of survival from COVID infection," said Narasimhan, who wasn't involved in the new study.

The research was led by Bertrand Cariou and Samy Hadjadj, diabetologists at University Hospital Nantes in France. In May of last year they had released preliminary findings that showed that 10% of COVID-19 patients with diabetes died within seven days of hospital admission.

The newer, updated results are from a larger number of patients -- close to 2,800 -- treated for COVID-19 at 68 hospitals across France. Their mean age was 70, nearly two-thirds were men, and many were overweight. About 40% were also experiencing various forms of complications from their diabetes.

During the 28 days after their admission to a hospital, 21% of patients died, the French team reported Feb. 17 in the journal Diabetologia.

Of those patients who survived at least one month, 50% were discharged from the hospital with a median stay of nine days; 12% were still hospitalized at day 28, and 17% had been transferred from their first hospital to another facility.

Younger age, routine diabetes therapy using the drug metformin, and having had symptoms longer prior to hospital admission were key factors associated with a higher likelihood of being discharged from the hospital, the researchers said.

Patients who regularly took insulin -- possibly indicating more advanced diabetes -- had a 44% higher risk of death than those who didn't take insulin, the investigators said. Long-term blood sugar control wasn't associated with patient outcomes, but a higher level of blood sugar at the time of hospital admission was a strong predictor of death and of a lower chance of discharge.

Dr. Barbara Keber directs family medicine at Glen Cove Hospital in Glen Cove, N.Y. Reading over the findings, she said they show "diabetes is clearly a significant risk factor for both need for ICU/ventilator care in the hospital as well as for death" within a month of admission.

Keber said it "makes sense" that people with complications from poorly controlled diabetes are at higher risk, since this creates a "pro-inflammatory state" that is similar to that seen in advanced COVID-19.

But Keber also cautioned that death rates may have improved for COVID-19 patients, including those with diabetes, over the past year.

"This study was done in the first wave of the pandemic, and many of the current treatment regimens and medications that were tried in the early phase have been found to not be beneficial and other treatment regimens have taken their place," she noted.

For example, "the current use of steroids for treatment may play a role in the [improved] prognosis of patients overall and especially for those with diabetes," Keber said.

More information

The American Diabetes Association has more on COVID-19.

SOURCES: Mangala Narasimhan, DO, director, critical care services, Northwell Health, New Hyde Park, N.Y.; Barbara Keber, MD, chair, family medicine, Glen Cove Hospital, Glen Cove, N.Y.; Diabetologia, news release, Feb. 17, 2021

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COVID Deaths High When Hospitalized With Diabetes - WebMD

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