Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

doi:10.1111/dom.14228

Multicenter Study

. 2021 Feb;23(2):391-403.

doi: 10.1111/dom.14228. Epub 2020 Nov 6.

Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Sarra Smati¹, Blandine Tramunt², Matthieu Wargny³, Cyrielle Caussy^{4

5}, Bénédicte Gaborit⁶, Camille Vatier^{7

8}, Bruno Vergès⁹, Deborah Ancelle¹⁰, Coralie Amadou¹¹, Leila A Bachir¹², Olivier Bourron^{13

14

15}, Christine Coffin-Boutreux¹⁶, Sara Barraud¹⁷, Anne Dorange¹⁸, Bénédicte Fremy¹⁹, Jean-François Gautier^{20

21}, Natacha Germain²², Etienne Larger²³, Stéphanie Laugier-Robiolle²⁴, Laurent Meyer²⁵, Arnaud Monier²⁶, Isabelle Moura²⁷, Louis Potier²⁸, Nadia Sabbah^{29

30}, Dominique Seret-Bégué³¹, Patrice Winiszewski³², Matthieu Pichelin¹, Pierre-Jean Saulnier³³, Samy Hadjadj¹, Bertrand Cariou¹, Pierre Gourdy²; CORONADO investigators

Affiliations

¹ Département d'Endocrinologie, Diabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU Nantes, Nantes, France.
² Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPS, Université de Toulouse, Toulouse, France.
³ CIC-EC 1413, Clinique des Données, CHU de Nantes, Nantes, France.
⁴ University of Lyon, CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France.
⁵ Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
⁶ Département d'Endocrinologie et de Diabétologie, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France.
⁷ APHP, Hôpital Saint-Antoine, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Département d'Endocrinologie, Paris, France.
⁸ Sorbonne Université, INSERM UMRS 938, Centre de Recherche Saint-Antoine, Paris, France.
⁹ Endocrinologie, Diabétologie, CHU Dijon, Hôpital du Bocage, Dijon, France.
¹⁰ Service de Diabétologie Endocrinologie, Centre Hospitalier Monod, Le Havre, France.
¹¹ Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France.
¹² Département de Diabétologie, Hôpital Franco-Britannique, Levallois Perret, France.
¹³ Sorbonne Université, Paris, France.
¹⁴ Assistance Publique-Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, INSERM, Centre de Recherche des Cordeliers, Paris, France.
¹⁵ Institute of Cardiometabolism and Nutrition, Paris, France.
¹⁶ Centre Hospitalier de Périgueux, Périgueux, France.
¹⁷ Département de Diabétologie, CHU de Reims, Reims, France.
¹⁸ Département de Diabétologie, Endocrinologie, Nutrition, CH Le Mans, Le Mans, France.
¹⁹ Centre Hospitalier AGEN-NERAC, Agen, France.
²⁰ Département de Diabétologie et Endocrinologie, Hôpital Lariboisière, APHP, Paris, France.
²¹ INSERM UMRS 1138, Université́ Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.
²² Service Endocrinologie CHU de Saint-Etienne et Laboratoire TAPE, Saint-Etienne, France.
²³ Service de Diabétologie, Hôpital Cochin, APHP, Université de Paris, Paris, France.
²⁴ Centre Hospitalier d'Auch en Gascogne, Auch, France.
²⁵ Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
²⁶ Département d'Endocrinologie, Diabétologie, Nutrition, Centre Hospitalier Louis Pasteur, Chartres, France.
²⁷ Unité Transversale de Diabétologie, Endocrinologie, Nutrition, Centre Hospitalier d'Albi, Albi, France.
²⁸ Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de Recherche des Cordeliers, INSERM, U-1138, Université de Paris, Paris, France.
²⁹ Département d'Endocrinologie et Maladies Métaboliques, André Rosemon, Hôpital de Cayenne, Université des Antilles et de la Guyane Française, Pointe à Pitre, France.
³⁰ EA3593, Amazon Ecosystems and Tropical Diseases, Université de Guyane, Guyane Française, France.
³¹ Centre Hospitalier de Gonesse, Gonesse, France.
³² Département de Diabétologie, Hôpital Nord Franche-Comté, Trévenans, France.
³³ Centre d'Investigation Clinique CIC 1402, Université de Poitiers, INSERM, CHU de Poitiers, Poitiers, France.

PMID: 33051976
PMCID: PMC7675375
DOI: 10.1111/dom.14228

Multicenter Study

Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

Sarra Smati et al. Diabetes Obes Metab. 2021 Feb.

. 2021 Feb;23(2):391-403.

doi: 10.1111/dom.14228. Epub 2020 Nov 6.

Authors

Affiliations

¹ Département d'Endocrinologie, Diabétologie et Nutrition, L'Institut du Thorax, INSERM, CNRS, University of Nantes, CHU Nantes, Nantes, France.
² Département d'Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPS, Université de Toulouse, Toulouse, France.
³ CIC-EC 1413, Clinique des Données, CHU de Nantes, Nantes, France.
⁴ University of Lyon, CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France.
⁵ Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
⁶ Département d'Endocrinologie et de Diabétologie, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France.
⁷ APHP, Hôpital Saint-Antoine, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Département d'Endocrinologie, Paris, France.
⁸ Sorbonne Université, INSERM UMRS 938, Centre de Recherche Saint-Antoine, Paris, France.
⁹ Endocrinologie, Diabétologie, CHU Dijon, Hôpital du Bocage, Dijon, France.
¹⁰ Service de Diabétologie Endocrinologie, Centre Hospitalier Monod, Le Havre, France.
¹¹ Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France.
¹² Département de Diabétologie, Hôpital Franco-Britannique, Levallois Perret, France.
¹³ Sorbonne Université, Paris, France.
¹⁴ Assistance Publique-Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié Salpêtrière-Charles Foix, INSERM, Centre de Recherche des Cordeliers, Paris, France.
¹⁵ Institute of Cardiometabolism and Nutrition, Paris, France.
¹⁶ Centre Hospitalier de Périgueux, Périgueux, France.
¹⁷ Département de Diabétologie, CHU de Reims, Reims, France.
¹⁸ Département de Diabétologie, Endocrinologie, Nutrition, CH Le Mans, Le Mans, France.
¹⁹ Centre Hospitalier AGEN-NERAC, Agen, France.
²⁰ Département de Diabétologie et Endocrinologie, Hôpital Lariboisière, APHP, Paris, France.
²¹ INSERM UMRS 1138, Université́ Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France.
²² Service Endocrinologie CHU de Saint-Etienne et Laboratoire TAPE, Saint-Etienne, France.
²³ Service de Diabétologie, Hôpital Cochin, APHP, Université de Paris, Paris, France.
²⁴ Centre Hospitalier d'Auch en Gascogne, Auch, France.
²⁵ Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
²⁶ Département d'Endocrinologie, Diabétologie, Nutrition, Centre Hospitalier Louis Pasteur, Chartres, France.
²⁷ Unité Transversale de Diabétologie, Endocrinologie, Nutrition, Centre Hospitalier d'Albi, Albi, France.
²⁸ Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de Recherche des Cordeliers, INSERM, U-1138, Université de Paris, Paris, France.
²⁹ Département d'Endocrinologie et Maladies Métaboliques, André Rosemon, Hôpital de Cayenne, Université des Antilles et de la Guyane Française, Pointe à Pitre, France.
³⁰ EA3593, Amazon Ecosystems and Tropical Diseases, Université de Guyane, Guyane Française, France.
³¹ Centre Hospitalier de Gonesse, Gonesse, France.
³² Département de Diabétologie, Hôpital Nord Franche-Comté, Trévenans, France.
³³ Centre d'Investigation Clinique CIC 1402, Université de Poitiers, INSERM, CHU de Poitiers, Poitiers, France.

PMID: 33051976
PMCID: PMC7675375
DOI: 10.1111/dom.14228

Abstract

Aim: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D).

Methods: From the CORONAvirus-SARS-CoV-2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19-related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.

Results: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m² , reference group), 726 (36.9%) overweight (25-29.9 kg/m² ) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m² ) and 314 (16.0%) with class II/III obesity (≥35 kg/m² ). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.

Conclusions: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.

Keywords: COVID-19, elderly, mechanical ventilation, obesity, prognosis, type 2 diabetes.

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Conflict of interest statement

C.C. reports personal fees from Novo Nordisk, Gilead, MSD, Eli Lilly and Astra Zeneca and grant support from Gilead. L.P. reports personal fees and non‐financial support from Sanofi, personal fees and non‐financial support from Eli Lilly, personal fees and non‐financial support from Novo Nordisk and personal fees and non‐financial support from MSD. B.F. reports personal fees and non‐financial support from Sanofi, Orkyn, Isis, MSD, NHC, Pfizer, Vitalair, Eli Lilly, Novo Nordisk, Merck and Servier. J.‐F.G. reports personal fees and non‐financial support from Eli Lilly, personal fees and non‐financial support from Novo Nordisk, personal fees and non‐financial support from Gilead and personal fees and non‐financial support from Astra Zeneca. A.M. reports personal fees support from Novo Nordisk. D.S.‐B. reports non‐financial support from Novo Nordisk, Sanofi, MSD and Lilly. M.P. reports personal fees and non‐financial support from Novo Nordisk, non‐financial support from Sanofi and non‐financial support from Amgen. S.H. reports personal fees and non‐financial support from Astra Zeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from Dinno Santé, personal fees from Eli Lilly, non‐financial support from LVL, personal fees and non‐financial support from Merck Sharpe Dome, personal fees from Novartis, grants from Pierre Fabre Santé, personal fees and non‐financial support from Sanofi, personal fees and non‐financial support from Servier and personal fees from Valbiotis. B.C. reports grants and personal fees from Amgen, personal fees from Astra‐Zeneca, personal fees from Akcea, personal fees from Genfit, personal fees from Gilead, personal fees from Eli Lilly, personal fees from Novo Nordisk, personal fees from Merck (MSD), grants and personal fees from Sanofi and grants and personal fees from Regeneron. P.G. reports personal fees from Abbott, personal fees from Amgen, personal fees from Astra‐Zeneca, personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, personal fees from Merck Sharp and Dohme, personal fees from Mundipharma, grants and personal fees from Novo Nordisk, personal fees from Sanofi and personal fees from Servier. All of the other authors declare no competing interests.

Figures

**FIGURE 1**
Flowchart. BMI, body mass index; IMV, intubation for mechanical ventilation; T2D, type 2 diabetes

**FIGURE 2**
Distribution of COVID‐19‐related outcomes by day 7 per age and body mass index (BMI) subgroups: A) Primary outcome; B) IMV; C) Death; D) Hospital discharge

See this image and copyright information in PMC

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References

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[1] Singh AK, Gillies CL, Singh R, et al. Prevalence of co‐morbidities and their association with mortality in patients with COVID‐19: a systematic review and meta‐analysis. Diabetes Obes Metab. 2020;22:1915‐1924. - PMC - PubMed

[2] Singh AK, Gillies CL, Singh R, et al. Prevalence of co‐morbidities and their association with mortality in patients with COVID‐19: a systematic review and meta‐analysis. Diabetes Obes Metab. 2020;22:1915‐1924. - PMC - PubMed

[3] Vas PRJ, Hopkins D, Feher MD, Rubino F, Martin MB. Diabetes, obesity and COVID‐19: a complex interplay. Diabetes Obes Metab. 2020;22:1892‐1896. - PMC - PubMed

[4] Vas PRJ, Hopkins D, Feher MD, Rubino F, Martin MB. Diabetes, obesity and COVID‐19: a complex interplay. Diabetes Obes Metab. 2020;22:1892‐1896. - PMC - PubMed

[5] Sun Y, Wang Q, Yang G, Lin C, Zhang Y, Yang P. Weight and prognosis for influenza a(H1N1)pdm09 infection during the pandemic period between 2009 and 2011: a systematic review of observational studies with meta‐analysis. Infect Dis. 2016;48(11‐12):813‐822. - PubMed

[6] Sun Y, Wang Q, Yang G, Lin C, Zhang Y, Yang P. Weight and prognosis for influenza a(H1N1)pdm09 infection during the pandemic period between 2009 and 2011: a systematic review of observational studies with meta‐analysis. Infect Dis. 2016;48(11‐12):813‐822. - PubMed

[7] Fezeu L, Julia C, Henegar A, et al. Obesity is associated with higher risk of intensive care unit admission and death in influenza a (H1N1) patients: a systematic review and meta‐analysis. Obes Rev. 2011;12(8):653‐659. - PubMed

[8] Fezeu L, Julia C, Henegar A, et al. Obesity is associated with higher risk of intensive care unit admission and death in influenza a (H1N1) patients: a systematic review and meta‐analysis. Obes Rev. 2011;12(8):653‐659. - PubMed

[9] Alqahtani FY, Aleanizy FS, Ali El Hadi Mohamed R, et al. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study. Epidemiol Infect. 2019;147:e35. - PMC - PubMed

[10] Alqahtani FY, Aleanizy FS, Ali El Hadi Mohamed R, et al. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study. Epidemiol Infect. 2019;147:e35. - PMC - PubMed

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Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

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Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

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