Survival Analysis Of COVID-19 Patients With Type 2 Diabetes: Lesson From Pandemic
Abstract
Type 2 diabetes mellitus (T2DM) is a common chronic comorbidity that exacerbates the clinical course of COVID-19, leading to higher complication rates and mortality. Patients with T2DM experience impaired immunity, persistent inflammation, and metabolic dysfunction, making them more vulnerable to severe viral infections. Despite extensive global research, evidence from Indonesia remains scarce, highlighting the need for local data to guide public health strategies. This study aimed to analyze the survival of COVID-19 patients with T2DM and identify factors associated with mortality in Padang City. A retrospective cohort study using surveillance data from the Padang City Health Office between March 2020 and March 2021 included 209 randomly selected patients. Survival analysis was conducted using Kaplan–Meier methods, and Cox regression models identified mortality predictors. The study found that 6.7% of patients died, with an incidence rate of 0.0058. T2DM patients had nearly four times the risk of death compared to non-diabetic individuals (HR = 3.9; 95% CI: 1.2–14.2). Other predictors included older age, male sex, multiple comorbidities, symptomatic status, and hospitalization. These findings emphasize the need to prioritize T2DM patients in vaccination, early detection, and integrated diabetes management to strengthen health system resilience.
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Ansbro, É., Heller, O., Vijayasingham, L., Favas, C., Rintjema, J., Chase-Vilchez, A., Stein, C., Issa, R., Sanga, L., Murphy, A., & Perel, P. (2024). Lessons from the COVID-19 pandemic to strengthen NCD care and policy in humanitarian settings: A mixed methods study exploring humanitarian actors’ experiences. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11458-2
Bonanad, C., García-Blas, S., Tarazona-Santabalbina, F., Sanchis, J., Bertomeu-González, V., Fácila, L., Ariza, A., Núñez, J., & Cordero, A. (2020). The effect of age on mortality in patients with COVID-19: A meta-analysis with 611,583 subjects. Journal of the American Medical Directors Association, 21(7), 915. https://doi.org/10.1016/J.JAMDA.2020.05.045
CDC. (2021). People with certain medical conditions and COVID-19 risk factors. https://www.cdc.gov/covid/risk-factors/index.html
COVID-19 Handling Task Force. (2021). The spread of COVID-19.
Coyle, P., Tripken, J., Perera, S., Juarez, G. A., Spencer-Brown, L., Cameron, K., & Brach, J. S. (2023). Dissemination and implementation of evidence-based programs for people with chronic disease: The impact of the COVID-19 pandemic. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1276387
Drew, C., & Adisasmita, A. C. (2021). Symptoms and comorbidities affecting mortality in COVID-19 positive patients in East Jakarta, March–September 2020. Tarumanagara Medical Journal, 3(1), 42–51. https://doi.org/10.24912/TMJ.V3I2.11742
Dwiyanti Simatupang, M., & Made Arcana, I. (2021). The risk of death in COVID-19 patients and factors that influence it. Seminar Nasional Official Statistics, 2021(1), 889–898. https://doi.org/10.34123/SEMNASOFFSTAT.V2021I1.1085
Goshua, G., Pine, A. B., Meizlish, M. L., Chang, C. H., Zhang, H., Bahel, P., Baluha, A., Bar, N., Bona, R. D., Burns, A. J., Dela Cruz, C. S., Dumont, A., Halene, S., Hwa, J., Koff, J., Menninger, H., Neparidze, N., Price, C., Siner, J. M., … Lee, A. I. (2020). Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. The Lancet Haematology, 7(8), e575–e582. https://doi.org/10.1016/S2352-3026(20)30216-7
Hodgson, K., Morris, J., Bridson, T., Govan, B., Rush, C., & Ketheesan, N. (2015). Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology, 144(2), 171–185. https://doi.org/10.1111/IMM.12394
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
Lestari, N., & Ichsan, B. (2021). Diabetes Mellitus as a Risk Factor for Severity and Mortality in COVID-19 Patients: A Meta-Analysis. Biomedika, 13(1), 83–94. https://doi.org/10.23917/BIOMEDIKA.V13I1.13544
Lim, S., Bae, J. H., Kwon, H. S., & Nauck, M. A. (2020). COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nature Reviews Endocrinology 2020 17:1, 17(1), 11–30. https://doi.org/10.1038/s41574-020-00435-4
Maryati, W., Widyastuti, A., Pinta, A., Rizky, K., Listyorini, P. I., & Aryanti, F. D. (2022). Analysis of characteristics in hospitalized COVID-19 patients. Journal of Health Science Research, 12.
Masriadi. (2017). Epidemiology of infectious diseases (2nd ed.). RajaGrafindo Persada.
Mi, J., Zhong, W., Huang, C., Zhang, W., Tan, L., & Ding, L. (2020). Gender, age and comorbidities as the main prognostic factors in patients with COVID-19 pneumonia. American Journal of Translational Research, 12(10), 6537. https://pmc.ncbi.nlm.nih.gov/articles/PMC7653634/
Ministry of Health of the Republic of Indonesia. (2020a). Decision of the Minister of Health of the Republic of Indonesia Number Hk.01.07/Menkes/413/2020 Concerning Guidelines for the Prevention and Control of Coronavirus Disease 2019 (COVID-19).
Ministry of Health of the Republic of Indonesia. (2020b). Guidelines for the Prevention and Control of Coronavirus Disease (COVID-19) - Revision 05.
Muniyappa, R., & Gubbi, S. (2020). COVID-19 pandemic, coronaviruses, and diabetes mellitus. American Journal of Physiology - Endocrinology and Metabolism, 318(5), E736–E741. https://doi.org/10.1152/AJPENDO.00124.2020.
Naveed, Z., Velásquez García, H. A., Wong, S., Wilton, J., McKee, G., Mahmood, B., Binka, M., Rasali, D., & Janjua, N. Z. (2023). Association of COVID-19 infection with incident diabetes. JAMA Network Open, 6(4). https://doi.org/10.1001/jamanetworkopen.2023.8866
Ong, K. L., Stafford, L. K., McLaughlin, S. A., Boyko, E. J., Vollset, S. E., Smith, A. E., Dalton, B. E., Duprey, J., Cruz, J. A., Hagins, H., Lindstedt, P. A., Aali, A., Abate, Y. H., Abate, M. D., Abbasian, M., Abbasi-Kangevari, Z., Abbasi-Kangevari, M., Abd ElHafeez, S., Abd-Rabu, R., … Vos, T. (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 402(10397), 203–234. https://doi.org/10.1016/S0140-6736(23)01301-6
Pari, B., Gallucci, M., Ghigo, A., & Brizzi, M. F. (2023). Insight on infections in diabetic setting. Biomedicines 2023, Vol. 11, Page 971, 11(3), 971. https://doi.org/10.3390/BIOMEDICINES11030971
Porzionato, A., Emmi, A., Barbon, S., Boscolo-Berto, R., Stecco, C., Stocco, E., Macchi, V., & De Caro, R. (2020). Sympathetic activation: A potential link between comorbidities and COVID-19. The Febs Journal, 287(17), 3681. https://doi.org/10.1111/FEBS.15481
Pradhan, A., & Olsson, P. E. (2020). Sex differences in severity and mortality from COVID-19: Are males more vulnerable? Biology of Sex Differences, 11(1). https://doi.org/10.1186/S13293-020-00330-7
Simeon, D. T., Cuba, V., Hunte, S. A., Barker, K., & de Habich, M. (2024). Intersectoral Collaboration In the COVID-19 Response in Latin America and the Caribbean. In International Journal for Equity in Health (Vol. 23, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s12939-024-02233-0
Sousa, G. J. B., Garces, T. S., Cestari, V. R. F., Florêncio, R. S., Moreira, T. M. M., & Pereira, M. L. D. (2020). Mortality and Survival of COVID-19. Epidemiology and Infection, 148, e123. https://doi.org/10.1017/S0950268820001405
Sutthiworapon, S., Vichitkunakorn, P., Choomalee, K., & Ngamchaliew, P. (2024). Effect Of Online Infographics For Enhancing Health Literacy Among Patients With Type 2 Diabetes In Primary Care Unit During The COVID-19 Pandemic: A Randomized Controlled Trial. BMC Primary Care, 25(1). https://doi.org/10.1186/s12875-024-02335-2
Wahdana, W., Rumahorbo, H., & Murtiningsih. (2020). Diabetes Mellitus as One of the Complications in the Recovery of COVID-19 Patients. Jurnal Kesehatan Kartika, 15(3). https://doi.org/10.1016/j.metabol.2020.1542
Wang, Y., Chai, X., Wang, Y., Yin, X., Huang, X., Gong, Q., Zhang, J., Shao, R., & Li, G. (2025). Effectiveness of different intervention modes in lifestyle intervention for the prevention of type 2 diabetes and the reversion to normoglycemia in adults with prediabetes: Systematic review and meta-analysis of randomized controlled trials. Journal of Medical Internet Research, 27. https://doi.org/10.2196/63975
West Sumatra Provincial Health Office. (2021). COVID-19 Information in West Sumatra. https://www.sumbarprov.go.id/home/news/19990-info-covid-19sumbar.html
WHO. (2021a). Coronavirus Disease (COVID-19) . https://covid19.who.int/
WHO. (2021b). Information Note on COVID-19 and NCDs. https://www.who.int/publications/m/item/covid-19-and-ncds
WHO. (2023). Working Together For Equity And Healthier Populations Sustainable Multisectoral Collaboration Based On Health In All Policies Approaches.
Yan, Y., Yang, Y., Wang, F., Ren, H., Zhang, S., Shi, X., Yu, X., & Dong, K. (2020). Clinical characteristics and outcomes of patients with severe COVID-19 with diabetes. BMJ Open Diabetes Research & Care, 8(1), e001343. https://doi.org/10.1136/BMJDRC-2020-001343
Yu, S., Wan, R., Bai, L., Zhao, B., Jiang, Q., Jiang, J., & Li, Y. (2023). Transformation of chronic disease management: Before and after the COVID-19 outbreak. In Frontiers in Public Health (Vol. 11). Frontiers Media S.A. https://doi.org/10.3389/fpubh.2023.1074364
Zhang, Y., Cui, Y., Shen, M., Zhang, J., Liu, B., Dai, M., Chen, L., Han, D., Fan, Y., Zeng, Y., Li, W., Lin, F., Li, S., Chen, X., & Pan, P. (2020). Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study. Diabetes Research and Clinical Practice, 165. https://doi.org/10.1016/j.diabres.2020.108227
Zheng, Y. Y., Ma, Y. T., Zhang, J. Y., & Xie, X. (2020). COVID-19 and the cardiovascular system. Nature Reviews Cardiology, 17(5), 259–260. https://doi.org/10.1038/S41569-020-0360-5
Zhou, J., Wang, Y., & Xu, R. (2024). Association of COVID-19 infection and the risk of new incident diabetes: A systematic review and meta-analysis. In Frontiers in Endocrinology (Vol. 15). Frontiers Media SA. https://doi.org/10.3389/fendo.2024.1429848
DOI: https://doi.org/10.33024/jdk.v15i1.23642
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