Diabetes Linked to Worse COVID-19 Outcomes in FA Patients
Diabetes increased chance of hospitalization, need for supplemental oxygen
People with Friedreich’s ataxia (FA) who also have diabetes, a condition that causes their blood glucose (sugar) level to become too high, are more likely than those who don’t have diabetes to have worse outcomes from COVID-19, according to a single-center study.
Having diabetes increased both the chance of getting admitted to the hospital and needing supplemental oxygen to help breathe. Understanding how COVID-19 behaves in people with FA “may guide future risk stratification in this population,” the researchers wrote.
The study, “SARS‐CoV‐2 in patients with Friedreich ataxia,” was published as a letter in the Journal of Neurology.
Anyone can get infected with SARS-CoV-2, the virus that causes COVID-19. The disease can bring about symptoms ranging from mild to very severe, but people with certain medical conditions are more likely to get very sick from it.
People with FA often have a wide range of symptoms, from muscle weakness and an abnormally curved spine (scoliosis) to heart muscle disease, called cardiomyopathy, and diabetes.
While having diabetes can generally make people get more sick from COVID-19, it’s unclear if this also applies with FA, leading a team of researchers to draw on data from 345 patients evaluated at the Children’s Hospital of Philadelphia or via telehealth who took part in FA-COMS (NCT03090789), a larger study underway at multiple locations across the U.S.
There were 180 female and 165 male FA patients. Their mean age was 27.2 and their first symptoms appeared at a mean age of 11.5.
Diabetes effect on FA patients
Of the 345 patients, 104 (30.1%) tested positive for SARS-CoV-2 sometime between Feb. 1, 2020 and June 2022. Most (92.3%) were either asymptomatic, meaning they showed no COVID-19 symptoms, or had mild or moderate symptoms.
Of those who got COVID-19, eight (7.7%) were admitted to the hospital, where they stayed for an average of 7.1 days and up to 18 days. Six (5.8%) received supplemental oxygen to help with breathing and had signs of lung infection (pneumonia) on a chest X-ray. Four (3.8%) also received remdesivir, an antiviral medication, and dexamethasone, a glucocorticoid. Two got getter with these medications, but the other two required intubation and died.
Those who got COVID-19 were a mean 3.7 years younger than those who didn’t get it. A significantly greater proportion of those who got COVID-19 were ambulatory or able to walk (60.6% vs. 47.3%).
The proportion of patients with diabetes was significantly higher among those who were hospitalized due to COVID-19 than among those with milder symptoms of it (67.5% vs. 6.3%). Having diabetes not only increased the risk of hospitalization, but also of needing supplemental oxygen. It didn’t increase the risk of getting infected with the virus, however.
On average, hospitalized patients were 11.5 years older than those who weren’t admitted (35.2 vs. 23.7 years). They also had more clinically advanced neurological disease as seen by higher scores on the modified FA Rating Scale (66.6 vs. 47.4 points).
Around two-thirds (66.8%) of all patients received at least one dose of a COVID-19 vaccine, with no major side effects. Of the 50 patients who got COVID-19 after receiving the vaccine, two were hospitalized and one died within two weeks after the second dose.
After adjusting for age and other factors, the researchers found that only diabetes remained an independent predictor of worse outcomes from COVID-19.
People with FA “otherwise demonstrate largely similar infection courses as those of the general population,” the researchers wrote. “Future investigation with an expanded cohort and updated vaccination data as novel SARS-CoV-2 variants emerge will continue to inform adaptations in care.”