Internal Medicine, Istanbul Kartal Dr Lufti Kirdar City Hospital, Istanbul, Turkey
Internal Medicine, Istanbul Kartal Dr Lufti Kirdar City Hospital, Istanbul, Turkey.
J Investig Med. 2022 Oct;70(7):1481-1487. doi: 10.1136/jim-2022-002363. Epub 2022 Jun 2.
COVID-19 infection is known to increase mortality in patients with diabetes. We aim to demonstrate the differences in disease course and clinical outcomes of patients with COVID-19 regarding the presence of impaired fasting glucose, pre-existing diabetes mellitus (DM) or new-onset DM. 236 patients with positive reverse transcription-PCR tests for SARS-CoV-2 were included in this single-center, retrospective observational study between March 2020 and May 2021. Laboratory results, comorbidities, medications and imaging findings were noted. Logistic regression was used to estimate associated factors for admission to the intensive care unit (ICU). 43 patients with normal glucose, 53 with impaired fasting glucose, 60 with newly diagnosed DM, and 80 with pre-existing DM were classified. Patients with pre-existing DM had higher fasting glucose and glycated hemoglobin than the other groups (p<0.001 for all). Patients with newly diagnosed DM were more likely to need dexamethasone 6 mg (p=0.001). In both newly diagnosed diabetes and impaired fasting glucose groups, 250 mg methylprednisolone was needed at higher rates (p=0.002). Newly diagnosed DM had higher rates of intubation (21.6%) and more mortality (20.0%) (p=0.045 and p=0.028, respectively). Mortality and hospitalization in the ICU were lower in the group receiving antidiabetic treatment. The risk of ICU attendance was higher in patients with impaired fasting glucose (HR=1.71, 95% CI: 0.48 to 6.08) and newly diagnosed DM (HR=1.88, 95% CI: 0.57 to 6.17), compared with pre-existing DM and non-diabetics. Newly diagnosed DM and impaired fasting glucose are associated with increased mortality and intubation in inpatients with COVID-19.
已知 COVID-19 感染会增加糖尿病患者的死亡率。我们旨在展示 COVID-19 患者中存在空腹血糖受损、预先存在的糖尿病（DM）或新发 DM 时疾病过程和临床结局的差异。这项单中心、回顾性观察研究纳入了 2020 年 3 月至 2021 年 5 月间经逆转录-聚合酶链反应（RT-PCR）检测 SARS-CoV-2 阳性的 236 例患者。记录实验室结果、合并症、药物和影像学发现。使用逻辑回归来估计入住重症监护病房（ICU）的相关因素。将血糖正常的 43 例患者、空腹血糖受损的 53 例患者、新诊断为 DM 的 60 例患者和预先存在 DM 的 80 例患者进行分类。预先存在 DM 的患者空腹血糖和糖化血红蛋白高于其他组（p<0.001）。新诊断为 DM 的患者更有可能需要地塞米松 6mg（p=0.001）。在新发糖尿病和空腹血糖受损组中，需要更高剂量的 250mg 甲基强的松龙（p=0.002）。新诊断为 DM 的患者插管率更高（21.6%），死亡率更高（20.0%）（p=0.045 和 p=0.028）。接受抗糖尿病治疗的患者 ICU 住院和死亡率较低。空腹血糖受损（HR=1.71，95%CI：0.48 至 6.08）和新诊断 DM（HR=1.88，95%CI：0.57 至 6.17）患者 ICU 就诊的风险高于预先存在 DM 和非糖尿病患者。新诊断的 DM 和空腹血糖受损与 COVID-19 住院患者的死亡率和插管增加相关。
