Diabetes Mellitus—A Risk Factor for Unfavourable Outcome in COVID-19 Patients—The Experience of an Infectious Diseases Regional Hospital

Abstract

Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even in patients with normal glycaemic status, COVID-19 may predispose to the development of hyperglycaemia which modulates immune mechanisms and inflammatory responses, with direct effects on morbidity and mortality. Thus, taking into account these scientific data, as well as the increased frequency of diabetes in the general population, we aimed to assess the risk of an unfavourable outcome of diabetic patients, which is in a strong connection with the presence and severity of pulmonary disease such as interstitial pneumonia/bronchopneumonia, as well as the effectiveness of Tocilizumab administration. The results of our study indicate a three-fold higher risk of death in patients with diabetes and COVID-19 (RR = 3.03; IC95%: 2.37–3.86; p = 0.001),compared to nondiabetic patients, and the risk of developing severe forms of acute respiratory failure was 1.5 times higher in the first studied category. In conclusion, we can say that the diabetic diagnosed with SARS-CoV-2 infection is more predisposed to immunological and organic dysfunctions that may ultimately result in death, and treatment with monoclonal anti-IL-6 antibodies was more effective in diabetic patients than non-diabetics (p < 0.05). The effectiveness of Tocilizumab was significant in both studied groups, but diabetic patients responded better to this therapy compared to non-diabetes-mellitus (DM) ones (76.7% vs. 35% p = 0.001).

Multidrug-Resistant (MDR) Urinary Tract Infections Associated with Gut Microbiota in CoV and Non-CoV Patients in a Urological Clinic during the Pandemic: A Single Center Experience

“…All operated patients also had antibiotic therapy, making it difficult to determine the separate involvement of urological maneuvers or antibiotic therapy in the occurrence of MDR UTIs; both probably play a role. The presence of diabetes, renal failure, anemia, and neoplasia has also been noted in other studies [ 22 , 23 ]. The longer hospital stay in CoV patients can be explained by the additional risk of CoV infection, which prolonged the evolution of the MDR UTI [ 16 , 24 ], and by the fact that more CoV patients presented with urosepsis, and therefore had more severe forms of MDR UTIs.…”

Predictive value of hematological and inflammatory markers for severity of COVID-19

“…This result supports the findings of a previous meta-analysis study of 1382 diabetic patients by Roncon et al, (14), who reported that COVID-19 patients who were diabetic had a significantly increased risk of ICU admission as compared to non-diabetic patients. In another study, Miftode et al (15) indicated that COVID-19 patients with diabetes have a threefold greater risk of death and 1.5 fold increased risk of developing severe form of acute respiratory failure in comparison to nondiabetics. The association of diabetes to severity of infection has been made to the increased glucose levels in blood as well as respiratory secretions enabling the virus to multiply faster in cells (16) Multivariate analysis of hematological parameters in this study highlighted that increased D-dimer, Ferritin and NLR as independent predictors for severity of COVID-19.…”

Predictors of COVID-19 severity among pregnant patients

“…Indeed, prior work has shown that even in cases of well-controlled pre-existing diabetes, hyperglycemia was commonly observed in acutely ill hospitalized patients and linked to adverse outcomes [44,45]. It seems that COVID-19 may lead to high blood glucose levels in patients with normal glycemic status by modulating immune and inflammatory responses, directly affecting morbidity and mortality [46][47][48]. In a study by Charoenngam et al in patients without a history of diabetes, hyperglycemia on the day of admission was shown to have a statistically significant association with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders.…”