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Background In this study, we aimed to compare the imaging findings between coronavirus disease (COVID-19) patients with well-controlled, poorly-controlled, and non-diabetic patients and subsequently find any relation between haemoglobin A1c (HbA1c) levels and high-resolution chest computed tomography (HRCT) chest score. Methodology A total of 200 individuals with coexisting COVID-19 and type 2 diabetes mellitus were included in this retrospective cohort study. Based on their HbA1c levels, patients were divided into three groups. The imaging data and laboratory values were obtained from the online medical records of the patients. In addition, the chest computed tomography (CT) score was evaluated as the sum of individual scores from five lung lobes: scores of 0, 1, 2, 3, 4, and 5 were assigned to each lobe. Any peripheral opacification pattern was noted. Haemoglobin A1c (HbA1c) levels and HRCT scores were then analysed by multiple linear regression models using R software. Results The prevalence of diabetes in the study population was 71.5%. Of this, 56 patients had well-controlled diabetes (28%) and 87 patients had poorly controlled diabetes (43.5%); 126 (63%) patients were male and the median age was 54.45 years (95% CI: 54.45 ± 15.53). We found that diabetes status, co-presence of ground-glass appearance with mixed consolidation, and consolidation and reverse halo sign in the HRCT findings were significant predictors of the HRCT scores in patients with COVID-19. Conclusions The presence of any co-morbidities should be viewed as a high-risk case of COVID-19. Diabetes status is significantly associated with the severity of HRCT findings in lab-confirmed COVID-19 infection. Therefore, it is important to prioritise the patients who have COVID-19 along with diabetes.

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), mainly type 1 DM. DM is one of the comorbidities recognized as the predictor of the severity in COVID-19-positive patients. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness (COVID-19) has a bidirectional association with DM. DM is a state of chronic inflammatory condition and hyperglycemia that predisposes one to acquire an exaggerated form of COVID-19 infection. Moreover, in recent literature, it has been established that SARS-CoV-2 is capable of directly damaging beta cells of the pancreas, thereby inducing new-onset diabetes in previously non-diabetics. Hence, new-onset diabetes and severe metabolic consequences of pre-existing diabetes, such as DKA, are seen in COVID-19-positive patients. DKA in patients with COVID-19 may increase the risk of mortality and lead to poor prognosis. MethodsThis retrospective observational study includes 25 patients who presented to our hospital with DKA secondary to COVID-19 infection as a triggering factor. Demographic parameters, medical history, physical examination, laboratory tests including reverse transcriptase polymerase chain reaction test (RT-PCR), chest X-ray, treatment administered, clinical course, and outcomes were recorded. All data were computed and analyzed using SPSS Version 22.0 (IBM Corp., Armonk, NY, USA). ResultsOf the 25 cases, 14 were females, and a statistically significant difference was seen in the values of blood sugar (367 mg/dL), D-dimer, ferritin, blood urea nitrogen (BUN), and anion gap among males and females (p < 0.050). The males had higher mean values of blood sugar (367 mg/dL), BUN (60.63 mg/dL), D-dimer (1.09 mcg/mL), and ferritin (821.23 mcg/mL) than females, whereas females had a higher anion gap (20.85) than males. A negative correlation was seen between D-dimer and the following biochemical investigations in COVID-19 patients: serum bicarbonate, anion gap, chloride, BUN, creatinine, sodium, potassium, magnesium, and phosphorous. COVID-19 can present with atypical symptoms in patients with high blood sugar levels. Diabetics are more likely to experience effects on multiple organs compared to non-diabetic patients who mainly have lung involvement. Hence, a high degree of suspicion is essential to diagnose DKA early in COVID-19 patients. ConclusionThese cases show that DKA can be precipitated by COVID-19 in a significant number of patients and that the presence of diabetes can also exaggerate the underlying COVID-19 infection, a bidirectional relationship. All cases were COVID-19-positive presenting with features characteristic of DKA. SARS-CoV-2 was precipitating factor of DKA. Patients with newly diagnosed diabetes or pre-existing diabetes were equally susceptible to DKA. Due to the high prevalence of both illnesses (DM and COVID-19) in our country, a high level of suspicion is required to detect DKA early and improve the outcome of COVID-19-related lifethreatening hyperglycemic consequences.

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