Impact of type 2 diabetes mellitus on clinical outcomes in patients with COVID-19 and cardiovascular disease

Introduction: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are independent risk factors for the severe course of COVID- 19. Thus, all patients with COVID-19, T2DM and CVD should be constant medical control and receive adequate therapy for concomitant diseases. Purpose: To study the effect of T2DM on the clinical outcomes of patients with COVID-19 and CVD. Methods: Retrospective analysis of clinical outcomes of 1665 patients with a confirmed diagnosis of COVID-19, depending on the presence of CVD, T2DM and received therapy. Results: The study included 866 men and 799 women;299 patients (17.96%) had T2DM. The average age of the patients was 57.56±15.04 years. We noted a high prevalence of CVD: 747 patients (44.9%) had hypertension, 362 patients (21.7%) - coronary heart disease (CHD): 109 (6.5%) - myocardial infarction, 23 (1.4%) - exertional angina, 106 (6.4%) - atrial fibrillation, 98 (5.9%) - chronic heart failure. The patients with T2DM had hypertension in 80% of cases and CHD in 42%. Overall, 65.2% of patients had at least 1 concomitant CVD. Mortality of patients with COVID-19 without concomitant pathology was 0.5%, and in the patients with CHD - 20.7%, with hypertension - 12.9%. Mortality in the patients without T2DM was 7.4%, in the patients with T2DM - 14.0%. Hyperglycemia was associated with a higher mortality rate: the median of glycemia was 5.7 mmol/L in discharged patients and 7.2 mmol/L in deceased patients, regardless of the presence of T2DM (p<0.001). The deceased patients had a higher level of HbA1c compared to those discharged (7.8% vs 8.1%). 24.6% of patients received antihypertensive therapy: 15.5% of patients received ACE inhibitors or ARBs, 11.9% - beta-blockers, 7.1% - thiazide and thiazidelike diuretics, 3.1% - calcium channel blockers. Statins were received by 2.4% of patients, antiplatelet drugs - 2.1%. The mortality rate of patients with COVID-19 and hypertension who received antihypertensive therapy was comparable to the mortality rate of the patients without hypertension: 8.8% and 9.0%, respectively. A significant decrease in mortality was observed during therapy with ACE inhibitors/ARBs (OR 0.39, 95% CI 0.21- 0.72, p<0.05), beta-blockers (OR 0.53, 95% CI 0.28-1, p<0.05). This decrease was more significant among patients with T2DM compared with patients without T2DM: a 2.27-fold decrease in mortality due to ACE inhibitors/ ARBs in the group without T2DM (OR 0.44, 95% CI 0.2-0.96, p<0.05), in the T2DM group - 4.76 times (OR 0.21, 95% CI 0.07-0.6, p<0.05);decrease in mortality against the background of beta-AB in the group without T2DM - by 1.72 times (OR 0.58, 95% CI 0.26-1.37), in the group with T2DM - by 3 times (OR 0.33, 95% CI 0.12-0.97, p<0.05). Conclusion: The presence of CVD and T2DM in the patients with COVID- 19 worsens the prognosis of COVID-19. But the adequate therapy for concomitant diseases can have a positive effect on this group of patients.

[Retrospective analysis of clinical outcomes of patients with COVID-19 depending on receiving antihypertensive, lipid-lowering and antihypertensive therapy].

BACKGROUND: The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19. AIM: Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT. MATERIALS AND METHODS: A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT. RESULTS: A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers ACE inhibitors/ARBs (OR 0.39, 95% CI 0.210.72; p0.05) and b-adrenergic blockers b-AB (OR 0.53, 95% CI 0.281; p0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.884.79; p0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.070.54; p0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.55.29; p0.05). CONCLUSION: A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.

Clinical characteristics of patients with covid-19 depending on the treatment received and the presence of type 2 diabetes mellitus

BACKGROUND. Type 2 diabetes mellitus (T2DM) is an independent risk factor for adverse clinical outcomes in patients with Covid-19. There is currently insufficient data evaluating the efficacy and safety of drugs for the treatment of COVID-19, especially in patients with T2DM. AIM. The aim of study was to identify an associative relationship between the drugs used and the clinical outcomes of patients with Covid-19 and T2DM. MATERIALS AND METHODS. A retrospective analysis of the clinical outcomes of 1753 patients with COVID-19 who were hospitalized to the redesignated departments of multidisciplinary city clinical hospital in the period from 23.03.2020 to 01.06.2020. RESULTS. The total number of patients is 1,753, of which 311 (17.7%) are patients with DM2. 92.6% of patients received treatment for COVID-19. At the same time, 91.4% of patients received antibiotics (a/b), 61.5% - bronchodilators, 56.6% - injectable anticoagulants (a/c), 45.2% - hydroxychloroquine, 6.3% - antiviral drugs, 5.4% - oral a/c, 4.6% - glucocorticosteroids (GCS), 1.9% - Tocilizumab. Decrease of risk of death among patients with COVID-19 was as the therapy of a/b (OR 0.07, 95% CI 0.05-0.11, p<0.05), bronchodilators (OR 0.12, 95% CI 0.08-0.18, p<0.05) and injection a/c (OR 0.47, 95% CI 0.34-0.67, p<0.05). At the same time, among patients with DM2, compared with patients without DM2, there was a more pronounced reduction in the risk of death during injectable a/c therapy: among patients with DM2, the risk of death decreased by 2.6 times (OR 0.39, 95% CI 0.21-0.73, p<0.05), among patients without DM2 - by 2.1 times (OR 0.47, 95% CI 0.31-0.71, p<0.05). Antiviral drugs was associated with an increased chance of death among patients without DM2 (OR 2.64, 95% CI 1.44-4.86, p<0.05) and among patients with DM2 (OR 4.98, 95% CI 2.11-11.75, p<0.05). CONCLUSION. A significant decrease of the risk of death among patients with COVID-19 was as the therapy of a/b, bronchodilators, and injectable a/c. An increase of the risk of death was observed during therapy with antiviral drugs.

Clinical and laboratory characteristics of patients with COVID-19 and concomitant type 2 diabetes

Aim. To assess the relationship between type 2 diabetes (T2D) and the course and outcomes of coronavirus disease 2019 (COVID-19), depending on clinical and laboratory parameters and comorbidities. Material and methods. A retrospective analysis of clinical outcomes was carried out in 1985 patients with documented COVID-19 who were admitted to the V.P. Demikhov City Clinical Hospital in the period from March 23, 2020 to June 01, 2020. Subsequently, 232 patients were excluded due to their transfer to another hospital. The final analysis included 1753 patients, of which 311 (17,7%) patients had T2D. Results. T2D was associated with an unfavorable outcome of COVID-19: mortality with and without — 16,1% and 7,4% (p<0,001). Age >60 years increased the mortality of patients with COVID-19, especially with concomitant T2D: patients <60 years of age without T2D — 2,2%, with T2D — 5,4% (p<0,05);patients >60 years of age without T2D — 15,6%, with T2D — 22,1% (p<0,01). Sex was not associated with mortality among COVID-19 patients. Among patients without T2D, the glycemia-depended mortality curves were U-shaped: 3,7% with glycemia <6,1 mmol/L, 1,1% with glycemia in the range of 6,1-7,0 mmol/L, 10,8% with glycemia >7,0 mmol/L (p<0,001). In patients with COVID-19 and T2D, a direct relationship was found between the level of glycemia and mortality: with glycemia <6,1 mmol/L, mortality rate was 8,3%, while with glycemia in the range of 6,1-7,0 mmol/L — 11,8% and glycemia >7 mmol/L — 15,6% (p<0,001). Any comorbidity worsened the outcome in COVID-19 patients. The highest mortality rate was observed in the presence of chronic obstructive pulmonary disease (46,2%;p<0,001), coronary artery disease (26,3%;p<0,001), cancer 25% (p<0,001). T2D significantly increased mortality among patients with chronic obstructive pulmonary disease — 33,3 vs 75% (p<0,05), asthma — 7,1 vs 60% (p<0,001), and cancer — 12,5 vs 62,5% (p<0,01). Conclusion. T2D is associated with unfavorable COVID-19 outcomes, especially among patients >60 years of age and high blood glucose levels. Any concomitant disease worsened the outcome of the disease. The main cause of death from COVID-19 were complications: acute respiratory distress syndrome, sepsis, acute renal failure, thrombotic events. © 2021 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.