Abstract
<jats:p>Diabetes mellitus is highly prevalent in the United States and increases the risk of severe illness in patients with COVID-19. We compared outcomes in hospitalized COVID-19 patients with and without diabetes using the National Inpatient Sample (2020-2022), adjusting for confounders via multivariable logistic regression. Among 5,934,565 hospitalizations for COVID-19, 2,155,978 (36.3%) had concomitant diabetes. The diabetes group had higher unadjusted in-hospital mortality (13.5% vs. 10.1%), but was not independently associated with mortality after adjustment (aOR 0.98; 95% CI 0.97-1.00). However, diabetes was independently associated with higher incidence of acute respiratory failure (46.1% vs 42.3%, aOR 1.29; 95% CI: 1.27-1.30), greater need for invasive mechanical ventilation (aOR 1.22; 95% CI 1.20-1.24) and non-invasive ventilation (aOR 1.27; 95% CI 1.25-1.29). These patients also had higher rates of ARDS, acute kidney injury, renal replacement therapy, sepsis, septic shock, and vasopressor use, along with longer length of hospital stay and higher total charges of hospitalization. Mortality among COVID-19 patients with diabetes declined through 2020-2022 (15.8% to 8.4%). Diabetes was not independently associated with in-hospital mortality but was associated with greater respiratory, renal, hemodynamic complications and hospital resource utilization. Early recognition and management of diabetes is warranted in patients with COVID-19.</jats:p>