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Research Snapshot Theater: Infectious Disease/Epidemiology - Outcomes, Adult

The Divergent Impacts of Diabetes on Critically Ill COVID-19 Patients: A Population-Level Analysis

Sunday, March 22, 2026
12:15 PM - 1:15 PM Central Time
Location: Connections Central - RST 05
Introduction: Diabetes mellitus (DM) among critically-ill COVID-19 patients has been associated with worse outcomes. However, the impact of diabetes with complications (DMC) versus diabetes without complications (DMNC) on mortality remains less explored. While both forms of diabetes may contribute to physiological vulnerability, the impact of DMNC on COVID-19 patients is not clear. This study aimed to evaluate the association between DM subtype and in-hospital mortality among ICU-admitted COVID-19 patients.


Methods: We used publicly available data to conduct a population-based cohort study of adults admitted to intensive care units of acute care hospitals in Texas during 2016 Q1 through Q2 2024 with a principal diagnosis of COVID-19. Transfers, nonemergency admissions, and discharges against medical advice were excluded. The population was identified using Clinical Classification Software Refined (CCSR) category INF012: COVID-19. The exposure was a three-level variable defined using CCSR categories END002: Diabetes mellitus without complications and END003: Diabetes mellitus with complications. The outcome was in-hospital mortality. Overlap propensity score weighting was applied with results expressed as adjusted risk ratio and 95% confidence interval (aRR [95% CI]).


Results: A total of 138,870 hospitalizations from 287 hospital were included in the study of which 23,510 (17%) had DMC and 37,137 (27%) had DMNC. In-hospital mortality was 14% for non-DM, 16% for DMNC, and 20% for DMC. In the overlap population, mortality was 18% for non-DM, 18% for DMNC, and 19% for DMC with DMNC was not associated with mortality compared to non-DM (aRR 1.0 [95% CI 0.9 to 1.0]) and DMC remaining associated with mortality compared to non-DM (aRR 1.1 [95% CI 1.0 to 1.1]).


Conclusions: Among ICU patients with a principal diagnosis of COVID-19, DMC was associated with increased in-hospital mortality compared patients without diabetes. In contrast, diabetes without complications did not significantly increase mortality risk after adjustment. These findings suggest that diabetes-related complications, rather than diabetes alone, are associated with the increased mortality among diabetic patients. This finding can assist in risk stratification of critically-ill COVID-19 patients.