Pushpa Saravanan, Rajkamal Ganesan, Dharmarajan Panneerselvam, PeriyandavarIyakannu, Saravanan Ravindra, Vasuki Ranganathan, Karthick Rajendran, Dhanasekar Ellappan, Venkateshwaran Raman, Porkodi Kulandasamy Ammapalayam, Jaya Packiam Thayanithi, Govarthanan Shanmugam, Abhideep Saravanan
Keywords
Diabetes mellitus • COVID-19 • Risk factors • Hyperglycemia management • Mortality
Background Diabetes mellitus is an immune compromised state and Covid-19 an infection associated with immune dysregulation. This study was conducted to appreciate the factors which may contribute to increased morbidity and mortality in people with Diabetes.
Objective To understand the profile of diabetes mellitus in COVID-19 patients and to ascertain their risk factors for mortality.
Methods This was a single-center, retrospective observational study conducted in a tertiary care hospital. The data of adults with established or newly diagnosed diabetes mellitus admitted with COVID-19 between April 2020 and January 2021 was analyzed in relation to their age, sex, duration of hospitalization, systolic blood pressure (SBP) at admission, presence of other comorbidities, initial fasting plasma glucose, oxygen therapy, CT severity, biochemical parameters, inflammatory markers, and hyperglycemia
management, and compared between survivors and non-survivors, to ascertain the risk factors for mortality.
Results A total of 2640 adults, above 18 years of age with diabetes mellitus and COVID-19, were included. Among them, 2229 (84.4%) survived, and 411 (15.6%) died. Preexisting diabetes mellitus was recorded in 2246 patients (85.1%) and newly diagnosed in 394 patients (14.9%) with mortality of 16.8% and 8.4% respectively. Multivariate logistic regression analysis showed odds ratio (OR) of 4.33 (95% CI= 2.533–7.402) for severity in CT chest and 3.9 (95% CI= 3.108–4.895) for use of oxygen therapy,
which were independently associated with in-hospital mortality in the study population and the risk was higher in adults aged more than 45 years, OR 2.035 (95% CI = 1.379–3.003). The subgroup of patients with risk factors like multiple comorbidities, fasting plasma glucose >140 mg/dl, and abnormal SBP also had higher levels of inflammatory markers and poorer outcomes.
Conclusion Based on our study, advanced age, extremes of SBP, uncontrolled fasting plasma glucose, and presence of other comorbidities like hypertension, coronary artery disease, chronic kidney disease, thyroid disorders, bronchial asthma, or COPD at admission appeared as risk factors for mortality in people with diabetes and COVID-19. Such patients had higher likelihood of elevated renal parameters, liver enzymes, C reactive protein, and more severe lung involvement, necessitating supplemental oxygen therapy. Interaction of all these parameters leads to higher morbidity and mortality in this population.
