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

Aims Obesity and diabetes have been identified as comorbidities frequently associated with severe forms of COVID-19. Here, we specifically assessed the relationship between 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 in 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 analyzed according to BMI status. Results Among 1,965 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 analyzed, 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 under 75 years, while such association was no longer found in those over 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 a specific management in this specific population. This article is protected by copyright. All rights reserved.