Outcomes in Patients with Diabetes Mellitus Affected by COVID-19

ABSTRACT

Background: An important prognostic factor in any form of infection seems to be glucose control in patients with diabetes mellitus. Therefore, we examined the effects of optimal glycemic control in patients with diabetes mellitus and affected by COVID-19. Interplay between severities of COVID-19 in earliest data on the pandemic. Relative risks of death 1.7 to 2.2 based on studies from China and Italy. People with diabetes appear to be at greater risk of severe disease. 31% mortality in Wuhan vs 14% hospitalized non DM. Most endemic related to T2DM rather than T1DM. Obesity and insulin resistance may be particular risk factors. Similar finding with previous SARS coronavirus outbreaks. (Ref, Wu, Jama 2020 Graselli Jama 2020 Zhon). Further study from France Coranado study including 1317 people with diabetes mellitus and COVID-19 in 53 hospitals, 88% with T2DM, 3% new diagnosis, mean BMI 28 kg/m2, HBA1c 65 mmol/mol. Primary endpoint death or ventilation at day 7. 410 required Intensive care unit admissions, 267 ventilated, 140 deaths and 237 patient discharged by day 7. Comprehensive dataset from UK comparing primary care and national diabetes audited data reported 33% of in hospital death related to COVID-19 occurred in people with diabetes (31.3% T2DM, 1.5% for type 1 diabetes). 5.1% of total individual population had diabetes. Adjusted relative risk of death of death 2.9% for type 1 diabetes, 1.8% for type 2 diabetes. It was also noted there is clear association between renal function and outcome with increased mortality with e GFR<60 ml/min/1.73 m2. Further data from the United States the authors further compared the outcome for those with hyperglycemia with those with normoglycemia at admission. 41% had poor outcome in those with hyperglycemia without known diabetes vs under 15% in context of COVID-19 for those with previous diabetes. Marked hyperglycemia at admission had strong impact on prognosis and the development of diabetes mellitus in context of COVID-19 is particular serious events. (Bode et al, J Diab Sci Tech, 2020). These worked was also identified a significant increase in total death in diabetes during 2020. Objective(s) To evaluate the effect of optimal glycemic control on the outcome for patients with type 2 diabetes affected by COVID- 19 infection. Method(s) This is a retrospective analysis of 100 patients with type 2 diabetes, who were affected by moderate disease of COVID-19 infection and admitted to Fujairah hospital (UAE), compared with 100 non diabetic patient admitted to the same hospital, with the same severity of COVID-19 disease. Result(s) Out of 200 patients studied, 100 patients were non-diabetic and 100 patients were having diabetes mellitus. In the diabetic group, all patients were diagnosed to have diabetes already before admission, and these 100 (100%) were treated with insulin infusion or basal -bolus regime. At baseline, D-dimer levels were not significantly higher in the diabetic group (mean D-dimer = 1.327) than in the normoglycemic group (mean of D-dimer = 1.544) (P < 0.001). Even though all patients were on standard treatment for COVID-19 infection, IL-6 and D-dimer levels persisted higher in patients with diabetes mellitus during hospitalization. Patients with diabetes had a higher risk of severe disease and prolonged length of stay and death 7% deceased (n=7), than those without diabetes and with normoglycemia.5% (n=5) deceased with length of stay of 13.7 days for diabetic group and 12.6 days for non-diabetic group. It was shown in our study, that there are contributory factors like hypertension which was found in 42% of our diabetic patients, and obesity that affect 34% of the same group, ischemic heart disease in three patients, could potentially contributed to the poor outcome and death. We looked to the effect of ethnicity in our patients outcome, the Emirati nationals contributed 14.29% (26) of the cohort, while 13.19% (n=24) were other Arab nationalities and 72.53% (n=132) were South-Asian (chart 5), it clearly showed those people of South-Asian background with high ctopic lipid and increased insulin resistance had worse outcome. Conclusion(s) Insulin infusion and basal/bolus regime was an effective method for achieving glycemic targets and improving outcomes in patients with COVID-19 and it was showed effect in reducing the rate of admission to an ICU, the use of mechanical ventilation and prevent death. Immediate evidence from our study, that COVID-19 was associated with particular challenges in diabetes management. High rate of ketosis and acidosis in people with type 2 diabetes (not normally, ketosis prone), extreme level of hyperglycemia and associated hyperosmolar. Associated with significant acute kidney injury in some cases. Extreme insulin resistance with very high insulin requirement. Many cases of new onset diabetes mellitus mostly required insulin. Some unusual biochemical features, marked fall in serum albumin, variable CRP, Ferritin response, raised D-dimer and high rate of thromboembolic complications. It was shown in our study, that there are contributory factors like hypertension, obesity, ischemic heart disease and presence of acute kidney injury, were potentially contributed to the poor outcome and death.