Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain
Authors: Ramos-Rincón Jose Manuel , Pérez-Belmonte Luis M , Carrasco-Sánchez Francisco Javier , Jansen-Chaparro Sergio , De-Sousa-Baena Mercedes , Bueno-Fonseca José , Pérez-Aguilar Maria , Cañas Coral Arévalo , Cebrian Marta Bacete , Méndez-Bailón Manuel , Mera Isabel Fiteni , García Andrés González , Romero Francisco Navarro , Almeida Carlota Tuñón de , Nicolás Gemma Muñiz , Noya Amara González , Milian Almudena Hernández , García Gema María García , Pedrajas José Nicolás Alcalá , García Virginia Herrero , Corral-Gudino Luis , Casanova Pere Comas , Míguez Héctor Meijide , Casas-Rojo José Manuel , Gómez-Huelgas Ricardo 
Published: December 2020

Abstract
Background

Advanced age and diabetes are both associated with poor prognosis in COVID-19. However, the effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥ 80 years with type 2 diabetes mellitus hospitalized for COVID-19.
Methods

We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years with type 2 diabetes mellitus and COVID-19 hospitalized in 160 Spanish hospitals between March 1 and May 29, 2020 who were included in the SEMI-COVID-19 Registry. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. The regression analysis values were expressed as adjusted odds ratios (AOR) with a 95% confidence interval (CI). In order to select the variables, the forward selection Wald statistic was used. Discrimination of the fitted logistic model was assessed via a receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow test for logistic regression was used to determine the model’s goodness of fit.
Results

Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95% CI 0.309–0.815, p = 0.005) and angiotensin receptor blockers (AOR 0.454, 95% CI 0.274–0.759, p = 0.003) were independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95% CI 1.092–2.842, p = 0.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins showed neutral association with in-hospital mortality. The model showed an area under the curve of 0.788.
Conclusions

We found important differences between cardiometabolic drugs and in-hospital mortality in older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers may reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins seem to have a neutral effect; and acetylsalicylic acid may be associated with excess mortality.