Impact of Type 2 Diabetes Mellitus on Severity and Outcomes of the Patients Admitted with COVID-19 Infection: A Case-Control Study
Keywords:
Case-control study, COVID-19, Diabetes MellitusAbstract
Background: COVID-19 pandemic caused global effects on health care, economics and society for a long period. Significant proportion of COVID-19 infected patients had diabetes mellitus. Meta-analysis showed increase on severity and mortality rate of COVID-19 in diabetes compared with non diabetes. In Thailand, a few clinical research to be conducted in case-control study to determine the effects of diabetes and in hospital glycemic control on outcomes of COVID-19.
Objective: This research aim was to compare the clinical presentations, laboratory findings, x-ray findings and treatment outcomes between patients admitted in the hospital by COVID-19 infection with diabetes and without diabetes and to determine factors contributing to the outcomes of COVID-19 in diabetic subgroup.
Method: A retrospective cohort study in case-control design was carried out. One hundred and eighty five cases of diabetes after 30 year of age was collected as a case. Age and sex matched for each selected case were served as control. Clinical, laboratory, radiological and treatment outcome information were analyzed in comparison between diabetes and non diabetes. Subgroup analysis in diabetic patients was performed to assess factors related to outcomes according to insulin treatment during admission. Chi-square and unpaired t-test were used in statistical analysis to determine the difference between groups.
Results: Clinical manifestations of COVID-19 infection were not different between diabetes and non diabetes. Diabetic group had more pulmonary infiltration, more white blood cell and neutrophil count at admission. On treatment and outcomes, diabetic group need more and longer antiviral treatment, more steroid treatment and oxygen treatment than non diabetic group. Severe pulmonary complication, ARDS, developed more significantly in diabetic group and need transfer for ventilatory support. Subgroup analysis of diabetic patients revealed that insulin treatment group had longer duration of antiviral treatment, higher percentage on steroid and high flow oxygen treatment and more ARDS which need transfer for mechanical ventilatory support than non insulin treatment group.
Conclusion: This study confirmed the impact of diabetes mellitus on clinical, laboratory findings, radiological findings and the severity, outcomes and complications of patients admitted with COVID-19 infection in comparison with non diabetes in Thai patients. The level of HbA1c at admission in diabetic patients did not affect the severity, outcomes and complications, but the need of insulin treatment during admission was the important predictor of poor clinical outcome.
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