Clinical Outcomes and Hospital Resource Utilization Among Hospitalized Patients with Diabetes Mellitus and COVID-19 Infection: Insights from United States National Inpatient Sample, 2020–2022

Background: Diabetes mellitus (DM) is highly prevalent in the United States and increases the risk of severe illness in patients with COVID-19. We compared outcomes among adult COVID-19 hospitalizations with and without DM. Methods: We compared the National Inpatient Sample (2020–2022), using multivariate regression to adjust for potential confounders. Results: Among 5,934,565 hospitalizations for COVID-19, 2,155,978 (36.3%) had concomitant DM. The DM group had higher unadjusted in-hospital mortality (13.5% vs. 10.1%) and was associated with higher mortality after adjustment (aOR 1.17; 95% CI, 1.15–1.19; p < 0.001). DM was also independently associated with higher odds of acute respiratory failure (46.1% vs. 42.3%; aOR 1.12; 95% CI, 1.11–1.13; p < 0.001), greater use of invasive mechanical ventilation (aOR 1.35; 95% CI, 1.33–1.37; p < 0.001) and non-invasive ventilation (NIV; aOR 1.42; 95% CI, 1.40–1.45; p < 0.001). COVID-19 hospitalizations with DM also had higher rates of acute respiratory distress syndrome, acute kidney injury, renal replacement therapy, sepsis, septic shock, and vasopressor use, along with longer length of hospital stay and higher total hospitalization charges. In-hospital mortality among COVID-19 hospitalizations with DM was lower in 2022 than in 2020 and 2021. Conclusions: DM was associated with higher in-hospital mortality and greater respiratory, renal, and hemodynamic complications and hospital resource utilization.