FRI624 Worse Outcomes Noted In Individuals With Chronic Kidney Disease And Type 1 Diabetes Hospitalized For Covid-19 Infection Compared To Type 2 Diabetes
Authors: Burguera-Couce Ella , Gopalakrishnan Geetha , Cheng Vicky , Monteiro Filipe 
Published: October 2023

Disclosure: E. Burguera-Couce: None. G. Gopalakrishnan: None. V. Cheng: None. F. Monteiro: None.

Objective: Our objective was to evaluate the impact of chronic kidney disease (CKD) stages on health outcomes in hospitalized individuals with Coronavirus disease 2019 (COVID-19) and type 1 diabetes (T1D) compared with type 2 diabetes (T2D). Methods: Data from 306 individuals with T1D admitted in Rhode Island with COVID-19 infection during the first-wave (March 1-June 30, 2020) and second-wave (July 1, 2020-February 28, 2021) were analyzed. Multivariate logistic regression was conducted to compare CKD stages for length of stay (LOS), ICU admission, mechanical ventilation (MV) and in-hospital mortality, and was adjusted for age, race/ethnicity, gender, insurance, and wave. Model investigating risk factors associated with poor outcomes (individuals admitted to ICU, being on MV or died in-hospital) was also adjusted in addition to BMI, hypertension (HTN), pulmonary disease, hyperglycemia, and LOS. The data was then compared to the results of our previously presented study with a cohort of 1122 individuals with type 2 diabetes (T2D), chronic kidney disease (CKD), and Coronavirus disease 2019 (COVID-19)1. Results: Average age 64.5 (±15.0) years; gender (54% male) and race/ethnicity (Caucasian 42%, Black 15% and Hispanic 29%) noted in T1DM cohort. CKD stages 1/2/3a, 3b/4, 5 represented 57.8%, 31.4% and 10.8%, respectively. Individuals with T1DM and CKD stages 4 & 5 were more likely to have LOS ≥1-week (OR 3.1 [1.55-7.05] and 5.3 [1.95-14.14] respectively) and ICU admissions (13.4 [5.64-31.63] and 15.3 [6.03-39.01] respectively). CKD stages 3b, 4 & 5 was associated with higher probability of MV (3.2 [1.18-8.67], 34.2 [10.77-108.52], 49.8 [14.37-172.73], respectively) and death (4.6 [1.9-19.15], 29.39 [7.90-109.34], 99.06 [20.90-469.54], respectively) in individuals with T1DM. These findings mirrored the trends found in individuals with DM21. However, the risk of poor outcomes was significantly higher in the T1DM cohort compared to T2DM for all CKD stages with mortality rates as high as 54.6% in individuals with DM1 and CKD Stage 5 compared to 28.6% in individuals with DM2 and CKD Stage 5. CKD stage-5 (17.4 [16.9-17.8]), CKD 3b/4 (4.9 [4.6-5.2]), hyperglycemia (7.5 [3.5-16.2]) and admission during the first-wave (2.7 [1.3-5.5]) were identified as risk factors for poor outcomes. Discussion/Conclusion: Our study showed that hospitalized individuals with T1D, CKD and COVID-19 experienced worse outcomes (i.e., MV, admission to the ICU, longer LOS and death) when compared to individuals with COVID-19, DM2 and CKD. Hyperglycemia was identified to be an independent risk factor for poor outcomes in this cohort. Reference: 1. Cheng V, Burguera-Couce E, Gopalakrishnan G, Monteiro F. “Poor Outcomes of Hospitalized COVID-19 Patients with Type 2 Diabetes and Chronic Kidney Disease.” Endocrine Practice, Volume 28, Issue 5, Supplement. https://doi.org/10.1016/j.eprac.2022.03.129.

Presentation: Friday, June 16, 2023