Skip to main content

Advertisement

SpringerLink
Log in

A study on clinical profile of diabetes mellitus in COVID-19 patients, hyperglycemia management, and risk assessment for mortality

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background

Diabetes mellitus is an immune compromised state and Covid-19 an infection associated with immune dysregulation. This study was conducted to appreciate the factors which may contribute to increased morbidity and mortality in people with Diabetes.

Objective

To understand the profile of diabetes mellitus in COVID-19 patients and to ascertain their risk factors for mortality.

Methods

This was a single-center, retrospective observational study conducted in a tertiary care hospital. The data of adults with established or newly diagnosed diabetes mellitus admitted with COVID-19 between April 2020 and January 2021 was analyzed in relation to their age, sex, duration of hospitalization, systolic blood pressure (SBP) at admission, presence of other comorbidities, initial fasting plasma glucose, oxygen therapy, CT severity, biochemical parameters, inflammatory markers, and hyperglycemia management, and compared between survivors and non-survivors, to ascertain the risk factors for mortality.

Results

A total of 2640 adults, above 18 years of age with diabetes mellitus and COVID-19, were included. Among them, 2229 (84.4%) survived, and 411 (15.6%) died. Preexisting diabetes mellitus was recorded in 2246 patients (85.1%) and newly diagnosed in 394 patients (14.9%) with mortality of 16.8% and 8.4% respectively. Multivariate logistic regression analysis showed odds ratio (OR) of 4.33 (95% CI= 2.533–7.402) for severity in CT chest and 3.9 (95% CI= 3.108–4.895) for use of oxygen therapy, which were independently associated with in-hospital mortality in the study population and the risk was higher in adults aged more than 45 years, OR 2.035 (95% CI = 1.379–3.003). The subgroup of patients with risk factors like multiple comorbidities, fasting plasma glucose >140 mg/dl, and abnormal SBP also had higher levels of inflammatory markers and poorer outcomes.

Conclusion

Based on our study, advanced age, extremes of SBP, uncontrolled fasting plasma glucose, and presence of other comorbidities like hypertension, coronary artery disease, chronic kidney disease, thyroid disorders, bronchial asthma, or COPD at admission appeared as risk factors for mortality in people with diabetes and COVID-19. Such patients had higher likelihood of elevated renal parameters, liver enzymes, C reactive protein, and more severe lung involvement, necessitating supplemental oxygen therapy. Interaction of all these parameters leads to higher morbidity and mortality in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. International Diabetes Federation. IDF diabetes atlas, 10th edn. Brussels, Belgium: 2021. [accessed 2023 May 23]. Available at: https://www.diabetesatlas.org.

  2. Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020;16(5):442–9. https://doi.org/10.2174/1573399815666191024085838.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Blot M, Bour JB, Quenot JP, et al. The dysregulated innate immune response in severe COVID-19 pneumonia that could drive poorer outcome. J Transl Med. 2020;18:457. https://doi.org/10.1186/s12967-020-02646-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;2020:430–6.

    Article  Google Scholar 

  5. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O’Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Khunti K, Del Prato S, Mathieu C, Kahn SE, Gabbay RA, Buse JB. COVID-19, hyperglycemia, and new-onset diabetes. Diabetes care. 2021;44(12):2645–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sathish T, Anton MC. Newly diagnosed diabetes in patients with mild to moderate COVID-19. Diabetes Metab Syndr-Clin Res Rev. 2021;15(2):569–71.

    Article  CAS  Google Scholar 

  8. Li Y, Zhou W, Yang L, You R. Physiological and pathological regulation of ACE2, the SARS-CoV-2 receptor. Pharmacol Res. 2020;157:104833. https://doi.org/10.1016/j.phrs.2020.104833.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. Am J Respir Crit Care Med. 2020;202(5):756–9. https://doi.org/10.1164/rccm.202001-0179LE.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dennis JM, Mateen BA, Sonabend R, Thomas NJ, Patel KA, Hattersley AT, Denaxas S, McGovern AP, Vollmer SJ. Type 2 diabetes and COVID-19-related mortality in the critical care setting: a national cohort study in England, March-July 2020. Diabetes Care. 2021;44(1):50–7. https://doi.org/10.2337/dc20-1444.

    Article  CAS  PubMed  Google Scholar 

  11. Mithal A, Jevalikar G, Sharma R, Singh A, Farooqui KJ, Mahendru S, Krishnamurthy A, Dewan A, Budhiraja S. High prevalence of diabetes and other comorbidities in hospitalized patients with COVID-19 in Delhi, India, and their association with outcomes. Diabetes Metab Syndr. 2021;15(1):169–75. https://doi.org/10.1016/j.dsx.2020.12.029.

    Article  CAS  PubMed  Google Scholar 

  12. Drucker DJ. Coronavirus infections and type 2 diabetes-shared pathways with therapeutic implications. Endocr Rev. 2020;41(3):1.

    Article  Google Scholar 

  13. Ethirajan T, Zahir Hussain S, Rajendran K, et al. Profile of COVID-19 patients at zero delay COVID-19 ward, in a tertiary care hospital in South India. J Prim Care Community Health. 2021. https://doi.org/10.1177/21501327211035094.

    Article  Google Scholar 

  14. Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, Deftereos S, Tousoulis D. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019;14(1):50–9. https://doi.org/10.15420/ecr.2018.33.1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Holman N, Knighton P, Kar P, O’Keefe J, Curley M, Weaver A, Barron E, Bakhai C, Khunti K, Wareham NJ, Sattar N, Young B, Valabhji J. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2020;8(10):823–33. https://doi.org/10.1016/S2213-8587(20)30271-0. ISSN 2213-8587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Rangankar V, Koganti DV, Lamghare P, Prabhu A, Dhulipala S, Patil P, Yadav P. Correlation between CT severity scoring and diabetes mellitus in patients with COVID-19 infection. Cureus. 2021;13(12):e20199. https://doi.org/10.7759/cureus.20199.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ong J, Dan YY, Low JG. The atypical presentation of COVID-19 as gastrointestinal disease: key points for primary care. Br J Gen Pract. 2020;70(696):360–1. https://doi.org/10.3399/bjgp20X710705.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ma WX, Ran XW. The management of blood glucose should be emphasized in the treatment of COVID-19. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020;51(2):146–50. https://doi.org/10.12182/20200360606. Chinese.

    Article  PubMed  Google Scholar 

  19. Peric S, Stulnig TM. Diabetes and COVID-19: disease-management-people. Wiener klinische Wochenschrift. 2020;132(13–14):356–61. https://doi.org/10.1007/s00508-020-01672-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sardu C, D’Onofrio N, Balestrieri ML, Barbieri M, Rizzo MR, Messina V, Maggi P, Coppola N, Paolisso G, Marfella R. Outcomes in patients with hyperglycemia affected by COVID-19: can we do more on glycemic control? Diabetes Care. 2020;43(7):1408–15. https://doi.org/10.2337/dc20-0723.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors wish to extend acknowledgements and thank all doctors, nurses, and supporting staff associated with COVID-19 care at MMC and RGGGH. We also thank Mr. S. Abhineeth, Mr. Gaurav Masiwal, and Mr.M.Vignesh for the help extended during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Institute of Diabetology, Rajiv Gandhi Government General Hospital (RGGGH), Madras Medical College, 131A, Tower I, 3rdFloor, Chennai, 03, India

    Pushpa Saravanan, Rajkamal Ganesan, Dharmarajan Panneerselvam, Periyandavar Iyakannu, Vasuki Ranganathan, Dhanasekar Ellappan, Venkateshwaran Raman, Porkodi Kulandasamy Ammapalayam, JayaPackiam Thayanithi & Govarthanan Shanmugam

  2. Southern Railway Head Quarter Hospital, Chennai, India

    Saravanan Ravindra

  3. Multi-Disciplinary Research Unit, Madras Medical College, Chennai, India

    Karthick Rajendran

  4. CRMI, Govt. Kilpauk Medical College, Chennai, Tamil Nadu, India

    Abhideep Saravanan

Authors
  1. Pushpa Saravanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajkamal Ganesan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dharmarajan Panneerselvam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Periyandavar Iyakannu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saravanan Ravindra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vasuki Ranganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karthick Rajendran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dhanasekar Ellappan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Venkateshwaran Raman
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Porkodi Kulandasamy Ammapalayam
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. JayaPackiam Thayanithi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Govarthanan Shanmugam
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Abhideep Saravanan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Pushpa Saravanan, Ganesan Rajkamal, Ravindra Saravanan, and Rajednran Karthick. The first draft of the manuscript was written by Pushpa Saravanan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: Panneerselvam Dharmarajan, Iyakannu periyandavar. Methodology: Panneerselvam Dharmarajan, Iyakannu periyandavar. Formal analysis and investigation: Ganesan Rajkamal, Rajendran Karthick. Writing the original draft preparation: Pushpa Saravanan, Ganesan Rajkamal, Ravindra Saravanan, Rajendran Karthick, Raman Venkateshwaran, Ammapalayam Kulandasamy Porkodi, Abhideep Saravanan. Data interpretation: Pushpa Saravanan, Ravindra Saravanan, Ranganathan Vasuki, Thayanithi Jayapackiam, Shanmugam Govarthanan, Abhideep Saravanan. Writing review and editing: Panneerselvam Dharmarajan, Iyakannu periyandavar, Ranganathan Vasuki, Ellappan Dhanasekar, Thayanithi Jayapackiam. Data acquisition: Ganesan Rajkamal, Ellappan Dhanasekar, Ammapalayam Kulandasamy Porkodi, Raman Venkateshwaran. Literature search: Ganesan Rajkamal, Shanmugam Govarthanan, Raman Venkateshwaran, Ammapalayam Kulandasamy Porkodi, Abhideep Saravanan. Critical revision: Ravindra Saravanan, Ranganathan Vasuki, Thayanithi Jayapackiam. Review for final approval: Pushpa Saravanan, Panneerselvam Dharmarajan, Iyakannu Periyandavar, Ellappan Dhanasekar. Statistical analysis: Rajendran Karthick.

Corresponding author

Correspondence to Pushpa Saravanan.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

Institutional Ethical Committee Approval was obtained. IEC, Madras Medical College, Chennai. IEC No. 030420.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saravanan, P., Ganesan, R., Panneerselvam, D. et al. A study on clinical profile of diabetes mellitus in COVID-19 patients, hyperglycemia management, and risk assessment for mortality. Int J Diabetes Dev Ctries (2023). https://doi.org/10.1007/s13410-023-01247-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13410-023-01247-8

Keywords

Search

Navigation