JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v4i1.2305 jpsim.v4i1.2305 Original Research Outcomes in Critical COVID 19 Infection Affected by Pre-Existing Diabetes Mellitus Saeed Bilal ayubian2019@gmail.com * Arshad Abdul Rehman Rehman Hafiz Muhammad Yasir Department of Nephrology, Pak Emirates Military Hospital Rawalpindi *Correspondence: Bilal Saeed (ayubian2019@gmail.com) 13 02 2023 2023 4 1 20 23 13 11 2022 29 11 2022 Copyright © 2023 The Author(s) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To determine the effect of pre-existing diabetes mellitus on disease course in COVID-19 infection.

 Methodology

This retrospective observational study was done from Jan 2021 to August 2021. We included patients with COVID-19 infection having a positive PCR for SARS-CoV-2. Exclusion criteria included missing data or a negative PCR for SARS-CoV-2. Patients were selected using consecutive sampling. Length of stay and death within hospital were compared amongst diabetic and non- diabetic patients.

 Results

The 279 patients were aged 52.53± 11.31 years. Of these, 216 (77.42%) were males and 92 (32.97%) had diabetes. They remained admitted for 10.18± 3.13 days. The period of hospitalization was similar in diabetics and non- diabetics (10.70± 3.51 days vs 9.92± 2.91 days; p=0.052). Amongst the diabetics, 43(46.74%) died in hospital in comparison with 53 (39.55%) non- diabetics (p=0.002). The risk of in-hospital death in diabetics was 1.673 (95% CI 1.207 - 2.319).

 Conclusion

Diabetes mellitus is linked with greater risk of death, longer duration of hospital stay and higher need for critical care and novel therapy in COVID-19 infection.

 Keywords hospital stay mortality pandemic pneumonia References Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-33. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-69. Li G, Chen Z, Lv Z, Li H, Chang D, Lu J. Diabetes mellitus and COVID-19: associations and possible mechanisms. Int J Endocrinol. 2021; PMC 7394378. Corrao S, Pinelli K, Vacca M, Raspanti M, Argano C. Type 2 diabetes mellitus and COVID-19: a narrative review. Front Endocrinol. 2021; 10.3389/fendo.2021.609470. Hui Y, Li Y, Tong X, Wang Z, Mao X, Huang L, et al. The risk factors for mortality of diabetic patients with severe COVID-19: A retrospective study of 167 severe COVID-19 cases in Wuhan. PLoS One. 2020; 15(12):e0243602. National Institutes of Health. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Maryland: Available from: [https://www.covid19treatmentguidelines.nih.gov/] Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020; 94(1):91-95. Chen Y, Gong X, Wang L, Guo J. Effects of Hypertension, Diabetes and Coronary Heart Disease on COVID-19 Diseases Severity: A Systematic Review and Meta-Analysis. medRxiv 2020;doi: 10.1101/2020.03.25.20043133. Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020; 31(6):1068-1077.e3. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14(4):813-821. Azar WS, Njeim R, Fares AH, Azar NS, Azar ST, El Sayed M, et al. COVID-19 and diabetes mellitus: how one pandemic worsens the other. Rev Endocr Metab Disord. 2020;21(4):451-463. Zhang W, Li C, Xu Y, He B, Hu M, Cao G, et al. Hyperglycemia and correlated high levels of inflammation have a positive relationship with the severity of coronavirus disease 2019. Mediators Inflamm. 2021; Article ID 8812304. Shauly-Aharonov M, Shafrir A, Paltiel O, Calderon-Margalit R, Safadi R, Bicher R, et al. Both high and low pre-infection glucose levels associated with increased risk for severe COVID-19: New insights from a population-based study. PLoS One. 2021; 16(7):e0254847. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol. 2020; 10.1016/j.jcv.2020.104354. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020; 584(7821):430-6. Saeed B, Arshad AR. Outcome of severe/critical Covid-19 infection in patients with and without diabetes mellitus. Khyber Med Univ J. 2021;13(Suppl 1):S9.