Published: 2022-08-29

Factors related to the death of diabetic patients with COVID-19 hospitalized in Joseph Raseta Befelatanana University Hospital in Antananarivo, Madagascar

Miora M. A. Andrianiaina, Tsikinirina V. Randrianomanana, Rija E. Raherison, Thierry Razanamparany, Sitraka A. Raharinavalona, Jean F. Rafamatanantsoa, Andrianirina D. P. Rakotomalala, Radonirina L. Andrianasolo


Background: Diabetes mellitus is associated with severe and even fatal forms of COVID-19. The objective of this study was to identify the factors linked to the death of COVID-19 diabetic patients in order to improve their care.

Methods: An analytical cross-sectional study was carried out in the endocrinology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar. It has concerned all the cases of COVID-19 diabetics (162 patients) recorded from April 2020 to July 2021 (16 months).

Results: In our study, the case fatality rate of COVID-19 in diabetics was 14.49%. Significant factors related to death, after univariate analysis, were:  vascular complications including nephropathy (OR=4.74), neuropathy  (OR=5.38) and ischemic heart disease (OR=3.9), presence of other comorbidities (OR=9.02), dyspnea (OR=4.60), seizures (OR=6.22) or alertness disorder (OR=4.35), lower oxygen saturation (p=0.04), pleurisy (OR=4.67), signs of cardiac decompensation (OR=3.46), an elevated mean blood sugar level (p<0.001), leukocytosis (p=0.02) and thrombocytopenia (p<0.001), impaired renal function (p=0.02) and pleurisy on chest imaging (OR=5.29).

Conclusions: Death factors in diabetics with COVID-19 can be diverse. They do not only include the cardiovascular complications of the diabetes, but also a worse clinical respiratory presentation on the admission, a higher inflammatory syndrome, and a greater imbalance of blood sugar during the hospitalization.



COVID-19, Death, Diabetes mellitus, Risk factors

Full Text:



Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA. 2020;323(8):709-10.

Worldometers, Coronavirus disease pandemic, 2021. Available at: Accessed 22 April 2020.

WHO. Coronavirus Disease (COVID-19) Pandemic, 2019. Available at: Accessed 22 April 2020.

Li X, Xu S, Yu M, Wang K, Tao Y. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allerg Clin Immunol. 2020;146(1):110-8.

Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumoniae. A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):395-403.

Xia C, Rao X, Zhong J. Role of T lymphocytes in type 2 diabetes and diabetes-associated inflammation. J Diabetes Res. 2017;2017:1-6.

Popov D, Simionescu M. Alterations of lung structure in experimental diabetes, and diabetes associated with hyperlipidaemia in hamsters. Eur Respir J. 1997;10:1850-8.

WHO. World Diabetes Report. WHO 2016. Available from: handle/10665/254648/9789242565256-fre.pdf?sequence=1. Accessed 22 April 2020.

Wargny M, Potier L, Gourdy P, Pichelin M, Amadou C, Benhamou PY, et al. Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study. Diabetologia. 2021;64(4):778-94.

Agarwal S, Schechter C, Southern W, Crandall JP, Tomer Y. Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care. 2020;43(10):2339-44.

Holman N, Knighton P, Kar P, O'Keefe J, Curley M, Weaver A, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2020;8(10):823-33.

Wu C, Zheng S, Chen Y, Zheng M. Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan 2019-nCoV, in the nasal tissue. MedRxiv. 2020.

D’Marco L, Puchades MJ, Romero-Parra M Gimenez-Civera E, Soler MJ, Alberto Ortiz A, et al. Coronavirus disease 2019 in chronic kidney disease. Clin Kidney J. 2020;13:297-306.

Fisher M, Neugarten J, Bellin E, Yunes M, Stahl L, Johns ST, et al. AKI in hospitalized patients with and without COVID-19: a comparison study. J Am Soc Nephrol. 2020;31:2145-57.

Patrice Darmon P, Bauduceau B, Lyse Bordier L, Bringer J, Chabrier G, Charbonnel B. Management of hyperglycemia in type 2 diabetes: position statement of the Francophone Diabetes Society. Médecine des maladies Métaboliques. 2017;11(6):577-93.

Popov D, Simionescu M. Alterations of lung structure in experimentaldiabetes, and diabetes associated with hyperlipidaemia in hamsters. Eur Respir J. 1997;10:1850-8.

Luo P, Qiu L, Liu Y, Liu XL, Zheng JL, Xue HY, et al. Metformin treatment was associated with decreased mortality in COVID-19 patients with diabetes in a retrospective analysis. Am J Trop Med Hyg. 2020:1-4.

Scheen AJ. Metformin and COVID-19: from cellular mechanisms to reduced mortality. Diabetes Metab. 2020;46(6):423-6.

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 2019. Eur Heart J. 2020;41:255-323.

Sultan A, Halimi S. Relationship between type 2 diabetes and COVID-19: an update. Médecine des maladies Métaboliques. 2021;15:9-14

Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020;8(1):e001343.

Meppiel E, Broucker TD. Neurological manifestations associated with SARS-CoV-2 infection. Pratique Neurologique. 2021;12(2):89-96.

Griffin DO, Jensen A, Khan M, Chin J, Chin K. Pulmonary embolism and increased levels of d-dimer in patients with coronavirus disease. Emerg Infect Dis. 2020;26(8):1941-3.

Li F, Cai Y, Gao C, Zhou L, Chen R, Zhang K, et al. Effects of diabetes and blood glucose on COVID-19 Mortality: a retrospective observational study. MedRXiv. 2021.

Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton EC, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-6.

Gallather EJ, LeRoith D, Bloomgarden Z. Review of hemoglobin A (1c) in the management of diabetes. J Diabetes. 2009;1:9-17.

Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020;189(5):846-7.

Abdennadher I, Rekik N, Nasr BB, Chaâbane A, Abid M. P1068 diabetes and thromboembolic complications. Diabetes Metab. 2013;39(S1):A47.

Recovery Collaborative Group: Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with COVID-19, preliminary report. N Engl J Med. 2020;384(8):693-704.

Uzzan B. Pharmacological effects of glucocorticoids. In: Chanson P, Young J, eds. Traité d’Endocrinologie. Paris: Lavoisier Médecine Sciences; 2019:1127(364-70).