Publication date: Dec 04, 2024

To examine inpatient COVID-19-related outcomes among patients with and without diabetes alone or with a history of established heart failure (HF) or established atherosclerotic cardiovascular disease (ASCVD). Observational study; longitudinal analysis of registry data. Hospitals in the USA reporting to the American Heart Association (AHA) COVID-19 Registry from January 2020 to May 2021. 20 796 individuals with diabetes (11 244 men; mean age 64. 2) and 30 798 without diabetes (15 980 men; mean age 59. 0) hospitalised for COVID-19 in the USA. Primary outcome measures were all-cause mortality, inpatient major adverse cardiovascular events (MACE) and/or inpatient mechanical ventilation. Secondary outcome measures included the association with diabetes and these outcomes among those with and without pre-existing ASCVD and HF and the association with insulin use and these outcomes in patients hospitalised for COVID-19. After adjustment for relevant covariates diabetes increased the risk of mortality (HR 1. 12, 95% CI: 1. 03 to 1. 21), MACE (HR 1. 32, 95% CI: 1. 17 to 1. 48) and mechanical ventilation (HR 1. 33, 95% CI: 1. 26 to 1. 42). Among patients with established ASCVD or HF, diabetes did not modify the risk of adverse outcomes. There was a significant difference in the risk of mortality between patients taking insulin compared with those who were not (HR 1. 32, 95% CI: 1. 01 to 1. 26); however, there was no difference in the risk of MACE or mechanical ventilation. Diabetes was associated with a higher risk of in-hospital all-cause mortality, MACE and need for mechanical ventilation in patients hospitalised for COVID-19. Diabetes was independently associated with adverse outcomes, particularly among those without pre-existing cardiovascular disease.

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