Poor prognosis indicators of type-2 diabetic COVID-19 patients

Abstract

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM–) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM– groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM– group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM– patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Predictors of New-Onset Diabetes in Hospitalized Patients with SARS-CoV-2 Infection

“…In the present study, a higher peak value of leucocytes and neutrophils was associated with NOD. These findings were consistent with prior literature, showing that in coronavirus infection, NOD patients developed higher leukocytosis with neutrophilia than patients without DM [ 8 ]. This could be a marker for degradation of the clinical condition, with a high risk of a poor outcome, as shown in a meta-analysis with a total of 3377 COVID-19 patients [ 50 ].…”

“…A high incidence of NOD in patients with SARS-CoV-2 infection was also previously reported. In a retrospective study reporting data from 453 patients admitted between January and March 2020 in Wuhan, China, Li et al [ 8 ] reported that 21.0% of COVID-19 patients without a previous diagnosis of DM had an FPG of 7.0 mmol/L or more and/or HbA1c of 6.5% or more. In another study enrolling 184 patients admitted for COVID-19 infection in Livingston, New Jersey between March and May 2020, Smith et al [ 21 ] reported that 15.8% of patients developed type 2 DM during the disease.…”

“…The current study showed that in patients with COVID-19, there is a higher percentage of people with NOD who needed ICU than patients without NOD ( p = 0.043). In 453 patients admitted for SARS-CoV2 infection, NOD patients were more likely to need ICU and invasive mechanical ventilation than normal glucose patients, due to the highest prevalence of coronavirus-related complications and longer hospital stay [ 8 ]. Yang et al [ 58 ] concluded that 54% of patients with coronavirus disease and NOD were admitted to ICU.…”

“…In the studies carried out so far, the morbidity [ 4 ] and the mortality [ 7 ] in patients with type 2 diabetes mellitus (DM) and the risk for severe/critical forms of COVID-19 were higher than in those without diabetes. This suggests that also DM is a negative prognostic factor [ 8 ].…”

Leukocyte metabolism in obese type 2 diabetic individuals associated with COVID-19 severity

“…Patients with preexisting DM2 also presented worse prognosis in SARS-CoV infection ( Booth, 2003 ; Yang et al, 2006 ; Gorjão et al, 2022 ). Epidemiological studies also indicated that DM2 is the primary comorbidity associated with severe or lethal MERS-CoV infections ( Al-Qahtani et al, 2018 ).…”