ANALYSIS OF RISK FACTORS FOR COVID-19-RELATED FATAL OUTCOME IN 337991 PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS IN 2020-2022 YEARS: RUSSIAN NATIONWIDE RETROSPECTIVE STUDY.

ABSTRACT

BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death. AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2). MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)). RESULT(S) Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1-8.8%;DM2-17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified in DM1 these were age >=65 years (OR =4.01, 95% CI 1.42-11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI 1.98-26.29);for T2DM age >= 65 years (OR =2.53, 95% CI 1.96-3.27), male (OR =1.51, 95% CI 1.23-1.84), duration DM >=10 years (OR =2.01, 95% CI 1.61-2.51), BMI >= 30 kg/m2 (OR =1.26, 95% CI 1.02-1.55), ASCVD/CKD (OR =1.49, 95% CI 1.01-2.04), history of diabetic coma (OR =12.97, 95% CI 1.89-88.99) and presence of disability (OR =1.40, 95% CI 1.14-1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact Insulin therapy (OR = 1.64, 95% CI 1.30-2.07), sulfonylureas (SU) (OR =1.51, 95% CI 1.23-1.84));dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI 0.39-0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI 0.46-0.88). Vaccination was the most important protective factor in both types of DM DM1 OR =0.19, 95% CI 0.06-0.59;SD2 OR =0.20, 95% CI 0.16-0.26. CONCLUSION(S) The common risk factor for fatal outcome in both DM1 and DM2 was age >=65 years;in DM1 - history of hypertension and DFS, in DM2 - male sex, diabetes duration >=10 years, BMI >=30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively. Copyright © Endocrinology Research Centre, 2022.