EC Pulmonology and Respiratory Medicine

Background: SARS-CoV-2 infection (Severe acute respiratory syndrome coronavirus2) has created a major and complex problem in health care worldwide since December 2019. Studies have shown that diabetes is associated with an increase in the risk and severity of COVID-19 disease, as it was found that high blood sugar reduces immunity and increases the rate of the virus replication.

On the other hand, some studies have concluded that the SARS-CoV-2 virus may attack pancreatic beta cells, causing a new occurrence of diabetes. Research is still being conducted in this field.

Objective: Studying the impact of diabetes on the course and prognosis of covid-19. And comparing the newly diagnosed diabetes (on admission) with the prior-to-admission diabetes on the prognosis of covid-19.

Materials and Methods: This retrospective analytical study was conducted on patients diagnosed with positive RT-PCR-SARS-COV-2 at Tishreen University Hospital in Lattakia between December 2021-June 2022, where we distributed the patients into diabetic and non-diabetic patients. We compared the need for ventilation and the mortality rate between the two groups.

Statistically significant variables were applied to the multivariate equation for variables and diabetes was determined as a risk factor. Diabetic patients were distributed into two groups, diabetes detected on admission, glucose > 126 mg/dl, and previously known diabetes (prior to admission). Then a comparison was conducted between them on the course and prognosis of covid-19.

Results: The research sample included 197 patients, their ages ranged from 34 to 70, mean age and SD 63.23 ± 14.2 years. 58.4% were males, 36% were diabetics (15.2% diabetes on admission, 20.8% previously known diabetes).

The need for invasive mechanical ventilation (IMV) (32.4% VS 11.1% p = 0.0001) and non-invasive (non-IMV) (39.4% VS 16.7% p = 0.0001) was higher among diabetics compared to non-diabetics. Mortality was also higher (71.8% VS 38.9% p = 0.0001).

Diabetes was associated with an increased rate of death (OR 3.8, 95% CI: 1.1 - 7.3), an increased rate of the need for invasive ventilation (OR 3.3, 95% CI: 1.5 - 9.9) and an increased rate of the need for non-invasive ventilation (OR 2.8, CI: 95% CI: 1.3 - 11.6). We also found that high blood sugar values during hospitalization were associated with an increased mortality (271.88 ± 98.04) VS (117.67 ± 56.5) p = 0.0001.

Comparing the patients with newly discovered diabetes (on admission) to patients with previously known diabetes, we found that the percentage of those who needed invasive ventilation was 46.7% VS 22% p = 0.02, and the death rate was 80% VS 65.9% p = 0.04 which is higher in patients with newly discovered diabetes compared to patients with previously known diabetes.

Conclusion: This study concluded the importance of monitoring and controlling blood sugar levels in diabetic patients due to the association of diabetes with a poor prognosis for COVID-19 in terms of the need for invasive ventilation, the need for non-invasive ventilation and mortality.

Keywords: COVID-19; SARS-CoV-2; Diabetes; Risk Factor

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