Four in ten diabetic patients hospitalized with COVID did not survive
No primeiro ano da pandemia no Brasil, uma disparidade silenciosa se instalou nas enfermarias: pacientes com diabetes morriam de COVID-19 em proporção significativamente maior do que os demais. Um estudo da Universidade Estadual do Ceará, publicado em 2022, quantificou esse abismo — 40,8% de mortalidade entre os diabéticos hospitalizados, contra 32% no geral — e revelou que a doença em si, independentemente da idade ou de outras condições, elevava em 15% o risco de morte. É um lembrete de que as grandes crises sanitárias raramente atingem a todos com a mesma força.
- Quase 42 mil pacientes diabéticos morreram durante internações por COVID-19 entre fevereiro e agosto de 2020, representando uma parcela desproporcional das mortes totais no Brasil.
- A tensão se aprofundava no próprio tratamento: medicamentos anti-inflamatórios essenciais para combater a COVID, como a dexametasona, podiam elevar a glicemia e agravar o quadro de quem já lutava para regular o açúcar no sangue.
- Pesquisadores ajustaram os dados para idade, sexo e comorbidades — e o risco elevado persistiu, indicando que o diabetes em si era um fator independente de morte, não apenas um marcador de fragilidade geral.
- Com a chegada das vacinas, o cenário melhorou consideravelmente, mas uma nova preocupação emergiu: pacientes diabéticos parecem estar super-representados entre os casos de COVID longa, com sintomas que se prolongam por meses.
- A mensagem dos pesquisadores permanece firme — para pessoas com doenças crônicas, a prevenção continua sendo a ferramenta mais confiável, mesmo após a vacinação.
Nos primeiros oito meses de 2020, enquanto a COVID-19 avançava pelo Brasil, um padrão perturbador se consolidava nas enfermarias. Entre os quase 400 mil pacientes hospitalizados com o vírus, cerca de um em cada três morreu. Entre os diabéticos, a proporção era ainda mais sombria: quatro em cada dez não sobreviveram. Essa disparidade — de 32% de mortalidade geral para 40,8% entre os diabéticos — tornou-se o centro de um estudo publicado em maio de 2022 por pesquisadores da Universidade Estadual do Ceará.
Os números revelavam algo além da coincidência. Pacientes diabéticos representavam cerca de 25% das internações por COVID, mas sua presença entre os óbitos era desproporcionalmente maior. Mesmo após ajustes estatísticos para idade, sexo e outras condições crônicas, o risco elevado persistia: diabéticos tinham 15% mais chance de morrer do que não diabéticos hospitalizados com o mesmo vírus. Em termos práticos, aproximadamente três mortes a cada vinte podiam ser atribuídas ao diabetes em si.
O pesquisador Thiago Garces explicou parte do mecanismo: medicamentos anti-inflamatórios usados no tratamento da COVID grave, como a dexametasona, podem elevar os níveis de glicose no sangue — criando um ciclo em que o tratamento de uma condição desestabiliza a outra. O próprio vírus também pode danificar o pâncreas e comprometer a função metabólica.
Garces foi cuidadoso ao contextualizar os dados. Com o avanço da vacinação, o risco para diabéticos diminuiu consideravelmente. Ainda assim, a vulnerabilidade não desapareceu — especialmente diante do fenômeno emergente da COVID longa, em que pacientes com distúrbios metabólicos prévios parecem enfrentar sintomas prolongados com maior frequência. Para os pesquisadores, a conclusão era clara: mesmo em um cenário pós-vacina, a prevenção continua sendo o recurso mais sólido para quem convive com doenças crônicas.
In the first eight months of 2020, as COVID-19 swept through Brazil, a pattern emerged in the hospital wards that would trouble researchers for years to come. Among the nearly 400,000 people admitted to hospitals with confirmed coronavirus infections, roughly one in three died. But for those patients who carried a diagnosis of diabetes, the calculus was grimmer: four in ten did not survive. That disparity—from 32 percent overall mortality to 40.8 percent among the diabetic subset—became the foundation of a study that researchers at Ceará State University would publish in May 2022, months after the acute phase of the pandemic had passed.
The numbers themselves tell part of the story. Of the 397,600 hospitalized COVID patients tracked through Brazil's official surveillance system between February and August 2020, about 127,000 died. Among them, roughly 42,000 had diabetes—a disease affecting approximately nine percent of Brazil's adult population. Yet diabetic patients made up only about 25 percent of all COVID hospitalizations. The gap between their representation in the hospital census and their representation in the death toll suggested something more than coincidence.
When the researchers adjusted their analysis to account for age, sex, and the presence of other chronic conditions, the elevated risk remained. Diabetic patients faced a 15 percent higher likelihood of death compared to non-diabetic patients hospitalized with the same virus. In practical terms, that meant roughly three deaths per twenty could be attributed to the presence of diabetes itself, independent of other factors that typically drive mortality in severe illness.
Thiago Garces, a nurse and researcher involved in the study, offered context for why diabetes proved so lethal in hospitalized COVID patients. The severe inflammation that characterizes critical COVID infection often requires treatment with anti-inflammatory medications like dexamethasone—drugs that, paradoxically, can raise blood sugar levels and worsen outcomes for people whose bodies already struggle to regulate glucose. The virus itself can damage the pancreas and other organs involved in metabolic function. The combination created a compounding crisis: the treatment for one condition could destabilize another.
Yet Garces was careful to note that the landscape had shifted substantially by the time the study appeared in print. Vaccination campaigns had begun, and the risk profile for diabetic patients had improved considerably. He emphasized to patients with diabetes that while the 2020 data reflected a genuine and severe threat, the availability of vaccines and booster doses had meaningfully reduced that danger. The vulnerability remained real—people with chronic diseases face particular risks from any viral infection—but it was no longer the near-certain death sentence the early pandemic data had suggested.
The concern that lingered, however, was longer and more diffuse. Researchers were beginning to document cases of long COVID, where symptoms persisted for months after the initial infection cleared. Diabetic patients appeared overrepresented among those experiencing extended illness. The full consequences of that phenomenon remained unclear. What happened when a person with an existing metabolic disorder contracted a virus that seemed to cause prolonged metabolic disruption? The answer was still being written. For now, the message from researchers was straightforward: prevention remained the most reliable tool, even for vaccinated people with chronic disease.
Citações Notáveis
The severe inflammation in critical COVID often requires anti-inflammatory drugs like dexamethasone, which can raise blood sugar levels and worsen outcomes for diabetic patients— Thiago Garces, nurse and researcher at Ceará State University
With vaccination and booster doses now available, diabetic patients face substantially reduced risk compared to the first year of the pandemic— Thiago Garces
A Conversa do Hearth Outra perspectiva sobre a história
Why did diabetes make COVID so much deadlier in 2020? Was it just that diabetic people were sicker to begin with?
Not entirely. The researchers controlled for age and other conditions, and diabetes still added a 15 percent mortality bump on its own. It's the combination—the virus damages metabolic organs, and the drugs used to treat severe COVID inflammation can spike blood sugar dangerously high.
So the treatment itself was making things worse for diabetic patients?
In a way, yes. Dexamethasone and similar anti-inflammatories are necessary to keep severe COVID patients alive, but they destabilize glucose control. For someone whose pancreas is already compromised by the virus and whose body can't regulate blood sugar normally, that's a compounding crisis.
The study looked at 2020 only. Has the picture changed since then?
Substantially. Vaccination has reduced the risk significantly. But researchers are now watching long COVID—where symptoms drag on for months. Diabetic patients seem to get hit harder by that too, and we don't yet know what chronic inflammation plus existing metabolic disease will mean years down the line.
So the danger shifted from acute death to something slower and less visible?
Exactly. In 2020, hospitalized diabetic patients faced a 40 percent chance of dying. Now the acute risk is lower, but the long-term effects of a virus that damages metabolic function in people who already have metabolic disease—that's still an open question.