Comparison of clinical and laboratory parameters of COVID-19 in diabetic patients using different glucose-lowering drugs: a retrospective study
Dr Sahar Rostami-Mansoor, Soraya Khafri, Seyedeh Farzaneh Jalali, Faezeh Mohsenipoor, Hadi Parsian, Masoumeh Bayani
doi:10.22088/crms.6.2.32
Background and Objective: Diabetes is a common metabolic disease that increases the risk of mortality of COVID-19. This study was done to compare the clinical characteristics and laboratory parameters of COVID-19 in diabetic patients using different glucose-lowering drugs to find out the proper predictors of disease severity. Methods: 157 diabetic patients with confirmed COVID-19 were enrolled in three groups according to the antidiabetic medications used before admission (metformin, insulin and sulfonylurea).
Findings: In 157 diabetic patients, the hospitalization length in the metformin group was lower than the no metformin group while duration of hospitalization and critical form of the disease in the insulin group were higher than the no insulin group. Furthermore, the levels of blood sugar, BUN, ALT and WBC were lower in the metformin group while ALP, ALT, BUN and creatinine levels were significantly higher in insulin group. In sulfonylurea group the levels of BUN and ALT were lower compared to the no sulfonylurea group. We also found that BUN and total bilirubin were the proper parameters to predict COVID-19 severity and mortality in metformin and insulin group respectively.
Conclusion: It seems that the outcomes of renal function test, bilirubin and O2 saturation are important parameters to predict COVID-19 severity in diabetic patients using different antidiabetic medications.
Current Research in Medical Sciences, 2022; 6(2): 32-49 The adjusted OR, crude OR, 95% CI, AUC, cut off, specificity and sensitivity are shown. P < 0.05 was considered as statistically significant. [ DOI: 10.22088
Discussion There is a strong association between diabetes and the mortality rate of COVID-19 (13, 14) . It seems that several disorders in diabetic patients, such as high expression of ACE2 receptors, chronic inflammation, hypertension, and nephropathy exacerbate the pathological processes of COVID-19 (15) . In the present retrospective study, we suggested important predictors of death and critical form of COVID-19 in diabetes patients taking different glucose-lowering medications. Our results revealed that despite matching age, gender, comorbidities, and use of ARBs and/or ACE inhibitors, some baseline characteristics differed significantly between the groups. The hospitalization length and the severity of COVID-19 were higher in insulin-group compared to no insulin group. This result is consistent with the result previously reported by Chen et al (12) . They reported that insulin usage was associated with a poor prognosis of COVID-19 in diabetic patients (12) . Another study showed that insulin therapy of diabetic patients after COVID-19 infection increased the mortality rate, induced systemic inflammation, and aggravated injuries of vital organs (9) . Therefore, they suggested that more attention is needed regarding diabetic patients with COVID-19..
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