The Impact of Diabetes-related Factors on the Severity and Outcome of COVID-19 Infection in Hospitalized Patients: A Descriptive-analytical Study

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Introduction: The COVID-19 pandemic is having a devastating impact on public health, with a higher risk of severe illness and mortality in vulnerable groups. Individuals with a history of diabetes are more prone to severe COVID-19. A collection of hyperglycemia, inflammation, and impaired immunity in diabetes, especially in poor glycemic control, notably increases the risk of COVID-19 severity. Hyperglycemia can trigger the release of inflammatory cytokines, highlighting the intricate relationship between glucose metabolism and inflammation, and contributing to cytokine storms that worsen COVID-19 severity. Understanding this relationship enables healthcare providers to develop personalized care strategies for managing blood glucose in diabetic patients, thereby reducing the risk of severe COVID-19 outcomes. This study aims to identify the factors that contribute to the severe outcomes of COVID-19 in patients with diabetes, to better understand and manage this critical combination. Methods: A total of 411 patients with COVID-19 infection referred to the Teaching Hospital of Mazandaran University of Medical Sciences, Sari, were included in this study. The COVID-19 severity was evaluated according to the World Health Organization (WHO) guidelines. All information including demographic, clinical, and laboratory data as well as severity and outcome of the disease were compared between diabetic and non-diabetic patients. Results: The diabetic patients had higher blood glucose (210.3 ±114.9 mg/dl) compared to nondiabetics (118.74 ±3.8 mg/dl) upon admission (p=0.0001). Diabetics also experienced more severe COVID-19 infection (p=0.048). Patients with severe COVID-19 had significantly higher blood glucose (168.5 ±12.8 mg/dl) than those with non-severe infection (136.6± 6.3 mg/dl) (p=0.013). Diabetics had higher erythrocyte sedimentation rates (ESR) compared to non-diabetics (52.25±2.4 vs. 43.81±1.8 mm/h, p=0.006). Diabetic patients taking ACEIs/ARBs had more severe COVID-19 infection (p=0.031). Conclusion: The study discovered a positive relationship between hyperglycemia and COVID-19 severity, as well as a higher risk of severe COVID-19 among patients taking ACEIs or ARBs.