Impacts of diabetes mellitus on clinical and para-clinical parameters among COVID-19 patients.

PURPOSE: Diabetes has several adverse effects on patients with coronavirus disease 2019 (COVID-19); however, the determinants of this effect are still poorly understood. It is tried in current study to evaluate impacts of type 2 diabetes, with and without other comorbidities, on the clinical, para-clinical, and outcome parameters among COVID-19 patients. METHODS: A case series was applied, which involved 406 COVID-19 patients admitted in the city of Shiraz, south-central Iran, from February 20 to April 29, 2020. Demographic data, medical history, laboratory finding, chest computed tomography (CT) scan reports, and clinical outcomes of patients with and without type 2 diabetes were compared. RESULTS: Results of the above-mentioned comparison showed that comorbidities such as HTN (35.5% vs. 13.7%, p < 0.001) and CVDs (26.2% vs. 13.4%, P = 0.002) were significantly more prevalent among the diabetic patients. Also, there was not any considerable difference between the chest CT severity parameters of both groups. After excluding all of the comorbidities except diabetes, it was found that the diabetic COVID-19 patients without other comorbidities had lower oxygen saturation level (P < 0.001), higher AST level (P = 0.037), higher BUN (P = 0.005), higher WBC counts (P = 0.025), lower lymphocyte counts (P = 0.029), and longer ICU admission duration (0.72 ± 2.83 vs. 1.71 ± 4.68, P = 0.046). CONCLUSION: The diabetic COVID patients are at higher risks of hypoxemia, longer ICU stays, and more renal and hepatic dysfunction. These achievements could be useful in order to prevent the deterioration of clinical conditions among diabetic COVID-19 patients; also, they have to be considered in the management strategies.

HLA, Immune Response, and Susceptibility to COVID-19.

The severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV-2) that appeared in December 2019 has precipitated the global pandemic Coronavirus Disease 2019 (COVID-19). However, in many parts of Africa fewer than expected cases of COVID-19, with lower rates of mortality, have been reported. Individual human leukocyte antigen (HLA) alleles can affect both the susceptibility and the severity of viral infections. In the case of COVID-19 such an analysis may contribute to identifying individuals at higher risk of the disease and the epidemiological level to understanding the differences between countries in the epidemic patterns. It is also recognized that first antigen exposure influences the consequence of subsequent exposure. We thus propose a theory incorporating HLA antigens, the "original antigenic sin (OAS)" effect, and presentation of viral peptides which could explain with differential susceptibility or resistance to SARS-CoV-2 infections.