Bhandari Sudhir, Rankawat Govind, Singh Ajeet, Gupta Vishal, Kakkar Shivankan
Department of General medicine, SMS Medical College and Attached Group of Hospital, Jaipur, Rajasthan India.
Department of Pharmacology, SMS Medical College and Attached Group of Hospital, Jaipur, Rajasthan India.
Int J Diabetes Dev Ctries. 2020 Sep;40(3):340-345. doi: 10.1007/s13410-020-00868-7. Epub 2020 Sep 2.
Diabetes mellitus may be associated with increased severity and enhanced mortality in COVID-19 infections. The present study was undertaken to evaluate the clinical presentation, laboratory parameters, radiological imaging, management, and outcome of COVID-19 infection in patients of diabetes mellitus and its association with glycemic control.
The present study was designed to evaluate the difference between uncontrolled and controlled diabetes for COVID-19 manifestations by enrolling 80 admitted COVID-19 patients. Patients were categorized into two groups, where group 1 had patients with uncontrolled diabetes as indicated by HbA1c > 8 g% and group 2 had patients with controlled diabetes as indicated by HbA1c < 8 g%. Information concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome was extracted from medical records for evaluation, interpretation, and association among both the groups.
COVID-19 patients with uncontrolled diabetes exhibited a severe symptomatic presentation, excessive uncontrolled inflammatory responses, and hypercoagulable state. Total leukocyte count, neutrophil-lymphocyte ratio, serum levels of IL-6, FDP, and D-dimer were significantly raised ( < 0.05) in case of uncontrolled diabetes as compared with controlled diabetes. Radiological findings detected by chest radiograph and computed tomography chest suggested severe lung involvement in uncontrolled diabetes. COVID-19 patients with uncontrolled diabetes required intensive treatment as compared with controlled diabetes group in terms of insulin therapy ( = 0.0226) and non-invasive ventilation ( = 0.0292). Patients with uncontrolled diabetes had higher mortality ( = 0.0375) and required prolonged hospitalization ( = 0.0479) as compared with controlled diabetes group.
From the current study, it can be concluded that uncontrolled diabetic condition might be a risk factor for severity and morbidity of COVID-19 patients. Uncontrolled diabetes mellitus might be responsible for an overall higher susceptibility for COVID-19 infection and severity in terms of symptomatic presentation, inflammatory storm, rapid pulmonary invasion, requirement of more intensive treatment, and a poor outcome.
糖尿病可能与2019冠状病毒病（COVID-19）感染的严重程度增加和死亡率上升有关。本研究旨在评估糖尿病患者COVID-19感染的临床表现、实验室参数、影像学表现、治疗及预后，以及其与血糖控制的关系。
本研究通过纳入80例COVID-19住院患者，旨在评估血糖控制不佳和血糖控制良好的糖尿病患者在COVID-19表现上的差异。患者分为两组，第1组为糖化血红蛋白（HbA1c）>8%表明血糖控制不佳的患者，第2组为HbA1c<8%表明血糖控制良好的患者。从病历中提取有关病史、临床表现、实验室检查结果、影像学表现、治疗及预后的信息，以评估、解释两组之间的相关性。
血糖控制不佳的COVID-19患者表现出严重的症状、过度的失控炎症反应和高凝状态。与血糖控制良好的糖尿病患者相比，血糖控制不佳的糖尿病患者的白细胞总数、中性粒细胞与淋巴细胞比值、血清白细胞介素-6（IL-6）、纤维蛋白降解产物（FDP）和D-二聚体水平显著升高（P<0.05）。胸部X线片和胸部计算机断层扫描检测到的影像学结果表明，血糖控制不佳的糖尿病患者肺部受累严重。与血糖控制良好的糖尿病组相比，血糖控制不佳的COVID-19患者在胰岛素治疗（P=0.0226）和无创通气（P=0.0292）方面需要强化治疗。与血糖控制良好的糖尿病组相比，血糖控制不佳的患者死亡率更高（P=0.0375），住院时间更长（P=0.0479）。
从目前的研究可以得出结论，血糖控制不佳的糖尿病状况可能是COVID-19患者病情严重程度和发病率的危险因素。血糖控制不佳的糖尿病可能导致COVID-19感染的总体易感性更高，在症状表现、炎症风暴、快速肺部侵袭、需要更强化治疗以及预后不良方面更为严重。
