Diabetes mellitus, clinical characteristics, and in-hospital mortality among adults hospitalized with COVID-19 in Addis Ababa, Ethiopia

Diabetes has been associated with increased COVID-19 mortality in population-based studies and meta-analysis estimated after adjustment for age, cardiovascular disease (CVD), obesity and glycemic control. The independent association with mortality after accounting for coexisting conditions remains uncertain in Ethiopian hospital settings. This study described clinical characteristics and examined the crude and adjusted explanatory association between diabetes mellitus and in-hospital mortality among adults hospitalized with COVID-19 at ALERT comprehensive specialized Hospital in Addis Ababa, Ethiopia. We conducted a single-center retrospective chart review of 133 adults with reverse-transcription polymerase chain reaction-confirmed COVID-19 admitted between March 13, 2020, and December 30, 2021. Data was abstracted from July 25 to August 30, 2022. The primary outcome was all cause in hospital mortality; secondary outcomes were clinical and laboratory differences by diabetes and survival status. Descriptive analyses, group comparisons, exploration bivariate and multivariable firth penalized logistic regression model were performed using IBM SPSS Statistics version 25. Covariates were selected based on preexisting clinical knowledge. Among 133 patients, 74 (55.6%) were male, 43 (32.3%) had diabetes, and 30 (22.6%) died in hospital. Patients with diabetes were older than those without diabetes (58 ± 14 vs. 49 ± 17 years; p < 0.01). Crude mortality was higher among patients with diabetes (34.9% vs. 16.7%; p = 0.02). Diabetes was also associated with hypertension, fever, loss of consciousness, inability to walk, higher HbA1c, C-reactive protein, white blood cell count, total bilirubin, creatinine, and random blood glucose, and lower lymphocyte percentage and serum sodium (all normal p-value). In the exploratory crude Firth analyses adjusted model, chronic cardiovascular disease remained associated with higher odds of mortality (adjusted odds ratio [aOR] 6.36, 95% CI 2.22–19.32; P = 0.001), and each additional hospital day was associated with lower odds of mortality (aOR 0.88, 95% CI 0.78–0.97; P = 0.011) since those died will not stay longer. Diabetes was not statistically significant after adjustment (aOR 2.02, 95% CI 0.74–5.50; P = 0.169), and neither were age, hypertension, or asthma. Among adults hospitalized with COVID-19 at ALERT comprehensive specialized Hospital, diabetes was associated with higher crude in-hospital mortality and a less favorable clinical and laboratory profile. However, the study did not provide sufficiently precise evidence that diabetes was independently associated with mortality after adjustment. Larger multicenter studies using prespecified causal models and detailed information on diabetes severity, glycemic control, and treatment are warranted. Not applicable.