Are Patients With Diabetes Mellitus at Increased Risk of COVID-19 Infection?

Year 2021, Volume: 2 Issue: 1, 38 - 44, 29.01.2021

Mehmet Sözen , Fatma Çölkesen , Şevket Arslan , Fatih Çölkesen , Melia Karaköse , İbrahim Erayman , Soner Demirbaş , Turgut Teke

Abstract

Background: The aim of this study was to examine the clinical course and outcomes of patients with diabetes mellitus (DM) with coronavirus disease-2019 (COVID-19).

Methods: This retrospective, single-center study included 185 adult patients diagnosed with COVID-19. All patients were separated into 4 groups. Group 1(n=79): patients with no accompanying disease, Group 2 (n=14): patients with only DM, Group 3 (n=31): patients with comorbid disease(s) including DM, Group 4 (n=61): patients with comorbid disease(s) without DM. Data about COVID-19 management and outcome were obtained from the medical records of the patients. COVID-19 was confirmed by real-time polymerase chain reaction (RT-PCR) from throat swab samples. All patients underwent chest x-rays or chest computed tomography.

Results: 185 patients diagnosed with COVID-19 were evaluated. The COVID-19 prognoses of the patients were classified as good, moderate and poor. No statistically significant difference was determined between the groups in terms of COVID-19 prognosis (p>0.05). While the rate of DM patients with a good prognosis was 20.4%, the DM patient rate increased up to 40% among moderate or poor prognosis patients. A statistically significant difference was observed between blood glucose levels and mortality (p: 0.008). Mortality due to COVID-19 pneumonia developed in 15 (8.1%) patients. Mortality increase was mostly encountered in the group with DM and accompanying comorbidities. It was observed that ACEI / ARB use had no effect on mortality.

Conclusions: Although the study results do not show a statistically significant effect of DM on the prognosis of COVID-19 patients, the higher rate of DM patients in the group with poor prognosis suggests that it may affect the severity of COVID-19. These results may be useful for clinicians in the management of DM patients with COVID-19.

Keywords

Diabetes Mellitus, Coronavirus, COVID-19, Prognosis

References

• 1. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Vol. 17, Nature Reviews Microbiology. Nature Publishing Group; 2019. p. 181–92.
• 2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 15;395(10223):497–506.
• 3. Frydrych LM, Bian G, O’Lone DE, Ward PA, Delano MJ. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol. 2018;104(3):525–34.
• 4. Alqahtani FY, Aleanizy FS, Ali El Hadi Mohamed R, Alanazi MS, Mohamed N, Alrasheed MM, et al. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: A retrospective study. 2018;147:1-5.
• 5. Yang JK, Feng Y, Yuan MY, Yuan SY, Fu HJ, Wu BY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23(6):623–8.
• 6. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Vol. 395, The Lancet. Lancet Publishing Group; 2020. p. 1225–8.
• 7. Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Vol. 8, The Lancet Diabetes and Endocrinology. Lancet Publishing Group; 2020. p. 546–50. CDC. Certain Medical Conditions and Risk for Severe COVID-19 Illness |
• 8.CDC. Avaliable at: https://www.cdc.gov/coronavirus/2019- ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed November 29, 2020.
• 9. CDC. Certain Medical Conditions and Risk for Severe COVID-19 Illness | CDC. Avaliable at: https://www.cdc.gov/coronavirus/2019- ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed November 29, 2020.
• 10. NIH. What’s new | COVID-19 Treatment Guidelines. 2020. Available at: https://www.covid19treatmentguidelines.nih.gov/whats-new/. Accessed November 29, 2020.
• 11. Knapp S. Diabetes and Infection: Is There a Link? - A Mini-Review. Gerontology. 2013;59(2):99–104.
• 12. Banik GR, Alqahtani AS, Booy R, Rashid H. Risk factors for severity and mortality in patients with MERS-CoV: Analysis of publicly available data from Saudi Arabia. Vol. 31, Virologica Sinica. Science Press; 2016. p. 81–4.
• 13. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62.
• 14. Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128–38.
• 15. Zhang Y, Cui Y, Shen M, Zhang J, Liu B, Dai M, et al. Association of diabetes mellitus with disease severity and prognosis in COVID-19: A retrospective cohort study. Diabetes Res Clin Pract. 2020;165:108227.
• 16. Liu Z, Li J, Huang J, Guo L, Gao R, Luo K, et al. Association Between Diabetes and COVID-19: A Retrospective Observational Study With a Large Sample of 1,880 Cases in Leishenshan Hospital, Wuhan. Front Endocrinol (Lausanne). 2020;11:478.
• 17. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Vol. 14, Diabetes and Metabolic Syndrome: Clinical Research and Reviews. Elsevier Ltd; 2020. p. 211–2.
• 18. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Vol. 46, Intensive Care Medicine. Springer; 2020. p. 846–8.
• 19. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol. 2020;127:104354.
• 20. National Institute for Health and Care Excellence Hypertension in adults: diagnosis and management. NICE guideline, 2019. Available at: https://www.nice.org.uk/guidance/ng136/resources/hypertensionin- adults-diagnosis-and-management-pdf-66141722710213. Accessed November 23, 2020
• 21. Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirusinduced lung injury. Nat Me. 2005;11(8):875–9.
• 22. Cure E, Cumhur Cure M. Comment on “Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19.” J Med Virol. 2020;92(9):1423–4.
• 23. Da Costa-Pessoa JM, Dos Santos Ruiz Figueiredo CF, Thieme K, Oliveira-Souza M. The regulation of NHE1 and NHE3 activity by angiotensin II is mediated by the activation of the angiotensin II type i receptor/phospholipase C/calcium/calmodulin pathway in distal nephron cells. Eur J Pharmacol. 2013;721(1–3):322–31.
• 24. Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020;9(1):45.
• 25. Hippisley-Cox J, Young D, Coupland C, Channon KM, Tan PS, Harrison DA, et al. Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people. Heart. 2020;106(19):1503–11.
• 26. Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality among Patients with Hypertension Hospitalized with COVID-19. Circ Res. 2020;126(12):1671–81.
• 27. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. Jama. 2020;323(20):2052.