Factors Affecting the Incidence, Progression, and Severity of COVID-19 in Type 1 Diabetes Mellitus
Amira S Ahmed, Wejdan S Alotaibi, Maha A Aldubayan, Ahmad H Alhowail, Amal H Al-Najjar, Sridevi Chigurupati, Rehab M Elgharabawy
BioMed Research International, doi:10.1155/2021/1676914
Objectives. This study screened for factors affecting coronavirus disease 2019 (COVID-19) incidence in type 1 diabetes mellitus (T1DM) patients, appraised vitamin D's efficacy in preventing COVID-19, and assessed the effects of clinical characteristics, glycemic status, vitamin D, and hydroxychloroquine administration on COVID-19's progression and severity in T1DM patients. Methods. This retrospective research on 150 adults was conducted at Security Forces Hospital, Riyadh, KSA. Participants were allocated to three groups (50/group): control, T1DM, and T1DM with COVID-19. Participants' fasting blood glucose (FBG), glycated hemoglobin (HbA1c), complete blood count, vitamin D, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, lactate dehydrogenase (LDH), prothrombin time, activated partial thromboplastin time, D-dimer, liver and kidney function, and hydroxychloroquine treatment were retrieved and analyzed. Results. The percentages of comorbidities and not taking hydroxychloroquine were significantly higher among T1DM patients with COVID-19 than patients with T1DM only. Mean vitamin D level was significantly lower in T1DM with COVID-19 patients than in the other two groups. Vitamin D showed a significant negative correlation with LDH, CRP, ESR, ferritin, and D-dimer, which was the most reliable predictor of COVID-19 severity in T1DM patients. Conclusion. Comorbidities and vitamin D deficiency are risk factors for COVID-19 in patients with T1DM. Patients who do not take hydroxychloroquine and have higher FBG and HbA1c levels are vulnerable to COVID-19. Vitamin D may be useful for preventing COVID-19 in T1DM patients. Comorbidities, higher FBG and HbA1c levels, not taking hydroxychloroquine, and vitamin D inadequacy elevate COVID-19 progression and severity in patients with T1DM.
Conflicts of Interest The authors declare that they have no conflicts of interest.
References
Ahn, Shin, Kim, Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19), Journal of Microbiology and Biotechnology
Aktas, A comprehensive review on rational and effective treatment strategies against an invisible enemy; SARS Cov-2 infection, Experimental Biomedical Research
Aktas, Hematological predictors of novel coronavirus infection, Revista da Associação Médica Brasileira
Ali, Role of vitamin D in preventing of COVID-19 infection, progression and severity, Journal of Infection and Public Health
Alqahtani, Schattenberg, Liver injury in COVID-19: the current evidence, United European Gastroenterology Journal
Bornstein, Rubino, Khunti, Practical recommendations for the management of diabetes in patients with COVID-19, The Lancet Diabetes and Endocrinology
Cai, Shi, Yang, Fasting blood glucose level is a predictor of mortality in patients with COVID-19 independent of diabetes history, Diabetes Research and Clinical Practice
Cavezzi, Troiani, Corrao, COVID-19: hemoglobin, iron, and hypoxia beyond inflammation. A narrative review, Clinics and Practice
Cheng, Li, Li, Ferritin in the coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis, Journal of Clinical Laboratory Analysis
Connors, Levy, COVID-19 and its implications for thrombosis and anticoagulation, Blood
Fang, Karakiulakis, Roth, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?, The Lancet Respiratory Medicine
Geerlings, Hoepelman, Immune dysfunction in patients with diabetes mellitus (DM), FEMS Immunology and Medical Microbiology
Greiller, Martineau, Modulation of the immune response to respiratory viruses by vitamin D, Nutrients
Haimei, Pathogenesis and treatment strategies of COVID-19-related hypercoagulant and thrombotic complications, Clinical and Applied Thrombosis/Hemostasis
Hashem, Alghamdi, Algaissi, Therapeutic use of chloroquine and hydroxychloroquine in COVID-19 and other viral infections: a narrative review, Travel Medicine and Infectious Disease
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Jin, Yang, Ji, Virology, epidemiology, pathogenesis, and control of covid-19, Viruses
Katsarou, Gudbjörnsdottir, Rawshani, Type 1 diabetes mellitus, Nature Reviews Disease Primers
Khalid, Jaffar, Khan, Hematological and biochemical parameters as diagnostic and prognostic markers in SARS-COV-2 infected patients of Pakistan: a retrospective comparative analysis, Hematology
Kishaba, Tamaki, Shimaoka, Fukuyama, Yamashiro, Staging of acute exacerbation in patients with idiopathic pulmonary fibrosis, Lung
Lavezzo, Franchin, Ciavarella, Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo, Nature
Li, Hu, Yu, Ma, Retrospective analysis of laboratory testing in 54 patients with severe-or critical-type 2019 novel coronavirus pneumonia, Laboratory Investigation
Ling, Luo, Zheng, Cai, Weng, Elevated fasting blood glucose within the first week of hospitalization was associated with progression to severe illness of COVID-19 in patients with preexisting diabetes: a multicenter observational study, Journal of Diabetes
Mayer-Davis, Lawrence, Dabelea, Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012, The New England Journal of Medicine
Ozma, Maroufi, Khodadadi, Covid diagnosis, Le Infezioni in Medicina
Pal, Bhansali, COVID-19, diabetes mellitus and ACE2: the conundrum, Diabetes Research and Clinical Practice
Patel, Jernigan, Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak-United States, MMWR. Morbidity and Mortality Weekly Report
Ponti, Maccaferri, Ruini, Tomasi, Ozben, Biomarkers associated with COVID-19 disease progression, Critical Reviews in Clinical Laboratory Sciences
Pranata, Lim, Huang, Raharjo, Lukito, Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression, Journal of the Renin-Angiotensin-Aldosterone System
Principi, Esposito, Chloroquine or hydroxychloroquine for prophylaxis of COVID-19, The Lancet Infectious Diseases
Rak, Bronkowska, Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of type 1 diabetes mellitus-a narrative review, Molecules
Raymondi, Hernández, Tratamiento conservador en pacientes COVID 19 con insuficiencia respiratoria 8 BioMed Research International ligera en un Hospital de primer nivel, Medicina Clínica
Robert, Al-Dawish, Mujammami, Al-Dawish, Type 1 diabetes mellitus in Saudi Arabia: a soaring epidemic, International Journal Of Pediatrics
Rod, Oviedo-Trespalacios, Cortes-Ramirez, A brief-review of the risk factors for covid-19 severity, Revista de Saúde Pública
Tang, Li, Wang, Sun, Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia, Journal of Thrombosis and Haemostasis
Thachil, Tang, Gando, ISTH interim guidance on recognition and management of coagulopathy in COVID-19, Journal of Thrombosis and Haemostasis
Torti, Torti, Regulation of ferritin genes and protein, Blood
Truman-Rosentsvit, Berenbaum, Spektor, Ferritin is secreted via 2 distinct nonclassical vesicular pathways, Blood
Velavan, Meyer, Mild versus severe COVID-19: laboratory markers, International Journal of Infectious Diseases
Wang, Dabbas, Laperriere, Direct and indirect induction by 1,25-dihydroxyvitamin D 3 of the NOD2/ CARD15-defensin β2 innate immune pathway defective in Crohn disease, The Journal of Biological Chemistry
Wang, Du, Zhu, Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients, Diabetes Research and Clinical Practice
Weitz, Fredenburgh, Eikelboom, A test in context: D-dimer, Journal of the American College of Cardiology
Xu, Chen, Wang, Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission, Life Sciences
Yan, Zhang, Goncalves, An interpretable mortality prediction model for COVID-19 patients, Nature Machine Intelligence
Yao, Ye, Zhang, In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clinical Infectious Diseases
Zemb, Bergman, Camargo, Vitamin D deficiency and the COVID-19 pandemic, Journal of Global Antimicrobial Resistance
Zhang, Long, Xiao, Yang, Toulon et al., Use of D-dimer in oral anticoagulation therapy, International Journal of Laboratory Hematology
Zhang, Yan, Fan, D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19, Journal of Thrombosis and Haemostasis
Zheng, Peng, Xu, Risk factors of critical & mortal COVID-19 cases: a systematic literature review and metaanalysis, The Journal of Infection
Zhu, Zhang, Wang, A novel coronavirus from patients with pneumonia in China, 2019, The New England Journal of Medicine
{ 'indexed': {'date-parts': [[2024, 1, 17]], 'date-time': '2024-01-17T13:58:32Z', 'timestamp': 1705499912875},
'reference-count': 50,
'publisher': 'Hindawi Limited',
'license': [ { 'start': { 'date-parts': [[2021, 11, 23]],
'date-time': '2021-11-23T00:00:00Z',
'timestamp': 1637625600000},
'content-version': 'unspecified',
'delay-in-days': 0,
'URL': 'https://creativecommons.org/licenses/by/4.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'published-print': {'date-parts': [[2021, 11, 23]]},
'abstract': '<jats:p>Objectives. This study screened for factors affecting coronavirus disease 2019 '
'(COVID-19) incidence in type 1 diabetes mellitus (T1DM) patients, appraised vitamin D’s '
'efficacy in preventing COVID-19, and assessed the effects of clinical characteristics, '
'glycemic status, vitamin D, and hydroxychloroquine administration on COVID-19’s progression '
'and severity in T1DM patients. Methods. This retrospective research on 150 adults was '
'conducted at Security Forces Hospital, Riyadh, KSA. Participants were allocated to three '
'groups (50/group): control, T1DM, and T1DM with COVID-19. Participants’ fasting blood glucose '
'(FBG), glycated hemoglobin (HbA1c), complete blood count, vitamin D, C-reactive protein '
'(CRP), erythrocyte sedimentation rate (ESR), ferritin, lactate dehydrogenase (LDH), '
'prothrombin time, activated partial thromboplastin time, D-dimer, liver and kidney function, '
'and hydroxychloroquine treatment were retrieved and analyzed. Results. The percentages of '
'comorbidities and not taking hydroxychloroquine were significantly higher among T1DM patients '
'with COVID-19 than patients with T1DM only. Mean vitamin D level was significantly lower in '
'T1DM with COVID-19 patients than in the other two groups. Vitamin D showed a significant '
'negative correlation with LDH, CRP, ESR, ferritin, and D-dimer, which was the most reliable '
'predictor of COVID-19 severity in T1DM patients. Conclusion. Comorbidities and vitamin D '
'deficiency are risk factors for COVID-19 in patients with T1DM. Patients who do not take '
'hydroxychloroquine and have higher FBG and HbA1c levels are vulnerable to COVID-19. Vitamin D '
'may be useful for preventing COVID-19 in T1DM patients. Comorbidities, higher FBG and HbA1c '
'levels, not taking hydroxychloroquine, and vitamin D inadequacy elevate COVID-19 progression '
'and severity in patients with T1DM.</jats:p>',
'DOI': '10.1155/2021/1676914',
'type': 'journal-article',
'created': { 'date-parts': [[2021, 11, 23]],
'date-time': '2021-11-23T18:20:15Z',
'timestamp': 1637691615000},
'page': '1-9',
'source': 'Crossref',
'is-referenced-by-count': 4,
'title': 'Factors Affecting the Incidence, Progression, and Severity of COVID-19 in Type 1 Diabetes '
'Mellitus',
'prefix': '10.1155',
'volume': '2021',
'author': [ { 'ORCID': 'http://orcid.org/0000-0002-3989-1408',
'authenticated-orcid': True,
'given': 'Amira S.',
'family': 'Ahmed',
'sequence': 'first',
'affiliation': [ { 'name': 'Department of Pharmacology & Toxicology, College of Pharmacy, '
'Qassim University, Qassim, Saudi Arabia'},
{ 'name': 'Hormones Department, Medical Research and Clinical Studies '
'Institute, National Research Centre, Giza, Egypt'}]},
{ 'given': 'Wejdan S.',
'family': 'Alotaibi',
'sequence': 'additional',
'affiliation': [{'name': 'College of Pharmacy, Qassim University, Qassim, Saudi Arabia'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-3277-1702',
'authenticated-orcid': True,
'given': 'Maha A.',
'family': 'Aldubayan',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Pharmacology & Toxicology, College of Pharmacy, '
'Qassim University, Qassim, Saudi Arabia'}]},
{ 'ORCID': 'http://orcid.org/0000-0003-1427-032X',
'authenticated-orcid': True,
'given': 'Ahmad H.',
'family': 'Alhowail',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Pharmacology & Toxicology, College of Pharmacy, '
'Qassim University, Qassim, Saudi Arabia'}]},
{ 'ORCID': 'http://orcid.org/0000-0001-9703-1177',
'authenticated-orcid': True,
'given': 'Amal H.',
'family': 'Al-Najjar',
'sequence': 'additional',
'affiliation': [ { 'name': 'Drug and Poison Information Specialist, Pharmacy Services, '
'Security Forces Hospital, Riyadh, Saudi Arabia'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-1081-2964',
'authenticated-orcid': True,
'given': 'Sridevi',
'family': 'Chigurupati',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Medicinal Chemistry and Pharmacognosy, College of '
'Pharmacy, Qassim University, Buraydah, Saudi Arabia'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-4399-8195',
'authenticated-orcid': True,
'given': 'Rehab M.',
'family': 'Elgharabawy',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Pharmacology & Toxicology, College of Pharmacy, '
'Qassim University, Qassim, Saudi Arabia'},
{ 'name': 'Department of Pharmacology & Toxicology, Faculty of Pharmacy, '
'Tanta University, Tanta, Egypt'}]}],
'member': '98',
'reference': [ {'key': '1', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/nrdp.2017.16'},
{'key': '2', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2018/9408370'},
{'key': '3', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa1610187'},
{'key': '4', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/molecules24010053'},
{'key': '5', 'doi-asserted-by': 'publisher', 'DOI': '10.4014/jmb.2003.03011'},
{'key': '6', 'doi-asserted-by': 'publisher', 'DOI': '10.15585/mmwr.mm6905e1'},
{'key': '7', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2001017'},
{'key': '8', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jinf.2020.04.021'},
{'key': '9', 'doi-asserted-by': 'publisher', 'DOI': '10.11606/s1518-8787.2020054002481'},
{'key': '10', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/j.1574-695X.1999.tb01397.x'},
{'key': '11', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/v12040372'},
{'key': '12', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(20)30183-5'},
{'key': '13', 'doi-asserted-by': 'publisher', 'DOI': '10.1182/blood-2017-02-768580'},
{'key': '14', 'doi-asserted-by': 'publisher', 'DOI': '10.1177/1076029620944497'},
{'key': '15', 'doi-asserted-by': 'publisher', 'DOI': '10.1177/2050640620924157'},
{'key': '16', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jacc.2017.09.024'},
{'key': '17', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41586-020-2488-1'},
{'key': '18', 'doi-asserted-by': 'publisher', 'DOI': '10.30714/j-ebr.2020463629'},
{ 'key': '19',
'first-page': '153',
'article-title': 'Covid diagnosis',
'volume': '2',
'author': 'M. A. Ozma',
'year': '2020',
'journal-title': 'Le Infezioni in Medicina'},
{'key': '20', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.medcli.2020.06.008'},
{'key': '21', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.tmaid.2020.101735'},
{'key': '22', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/10408363.2020.1770685'},
{'key': '23', 'doi-asserted-by': 'publisher', 'DOI': '10.1590/1806-9282.67.suppl1.20200678'},
{'key': '24', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/jth.14810'},
{'key': '25', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2213-8587(20)30152-2'},
{'key': '26', 'doi-asserted-by': 'publisher', 'DOI': '10.1177/1470320320926899'},
{'key': '27', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2213-2600(20)30116-8'},
{'key': '28', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s11427-020-1637-5'},
{'key': '29', 'doi-asserted-by': 'publisher', 'DOI': '10.4081/cp.2020.1271'},
{'key': '30', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/1753-0407.13121'},
{'key': '31', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.diabres.2020.108214'},
{'key': '32', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.diabres.2020.108132'},
{'key': '33', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.diabres.2020.108437'},
{'key': '34', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/nu7064240'},
{'key': '35', 'doi-asserted-by': 'publisher', 'DOI': '10.1074/jbc.C109.071225'},
{'key': '36', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jiph.2020.06.021'},
{'key': '37', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jgar.2020.05.006'},
{'key': '38', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S1473-3099(20)30296-6'},
{'key': '39', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciaa237'},
{'key': '40', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/16078454.2021.1950898'},
{'key': '41', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s00408-013-9530-0'},
{'key': '42', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s42256-020-0180-7'},
{'key': '43', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/jcla.23618'},
{'key': '44', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41374-020-0431-6'},
{'key': '45', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijid.2020.04.061'},
{'key': '46', 'doi-asserted-by': 'publisher', 'DOI': '10.1182/blood.V99.10.3505'},
{'key': '47', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/jth.14859'},
{'key': '48', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/ijlh.12864'},
{'key': '49', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/jth.14768'},
{'key': '50', 'doi-asserted-by': 'publisher', 'DOI': '10.1182/blood.2020006000'}],
'container-title': 'BioMed Research International',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'http://downloads.hindawi.com/journals/bmri/2021/1676914.pdf',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'http://downloads.hindawi.com/journals/bmri/2021/1676914.xml',
'content-type': 'application/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'http://downloads.hindawi.com/journals/bmri/2021/1676914.pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 11, 23]],
'date-time': '2021-11-23T18:20:25Z',
'timestamp': 1637691625000},
'score': 1,
'resource': {'primary': {'URL': 'https://www.hindawi.com/journals/bmri/2021/1676914/'}},
'subtitle': [],
'editor': [{'given': 'San-Ji', 'family': 'Gao', 'sequence': 'additional', 'affiliation': []}],
'short-title': [],
'issued': {'date-parts': [[2021, 11, 23]]},
'references-count': 50,
'alternative-id': ['1676914', '1676914'],
'URL': 'http://dx.doi.org/10.1155/2021/1676914',
'relation': {},
'ISSN': ['2314-6141', '2314-6133'],
'subject': [ 'General Immunology and Microbiology', 'General Biochemistry, Genetics and Molecular Biology',
'General Medicine'],
'container-title-short': 'BioMed Research International',
'published': {'date-parts': [[2021, 11, 23]]}}
