Endocrine Abstracts

Patients with type 2 diabetes mellitus (DM) are one of the most vulnerable categories of patients in terms of adverse outcomes of COVID-19 infection.

Aim: To assess the features of laboratory and instrumental data in patients with COVID-19 and type 2 DM (unvaccinated) depending on the value of glycated hemoglobin (HbA1c) at the time of the onset of oxygen deficiency.

Materials and methods: The study involved 78 patients with type 2 DM and COVID 19. All the participants were divided into 2 groups. Group 1 (n = 47) included patients with HvA1c≤7.0%, group 2 (n = 31) - ≥7.0%. The patients underwent computed tomography scan of the lungs (CT), assessment of blood oxygen saturation level (SpO2), HbA1c, C-reactive protein(CRP), ferritin, D-dimer, complete blood count on the 6-9th day of the disease.

Results: Analyzing the obtained results it was revealed that in patients of group 1 the duration of type 2 DM was 7.0 [6.0;7.5] years vs 8.9 [7.0;10.0] years in group 2 (P = 0.031). The HbA1 was significantly higher in group 2 -8.5 [8.0;9.8]% vs 7,0 [6.7;7.0]%, (P = 0.001). So, in group 1 at the time of hospitalization SpO2 was 91.0 [90.0;93.0]% vs 87.0 [86.0;89.0]% (P = 0.005). All the patients had bilateral interstitial pneumonia, the median value of the percentage of lung tissue damage in group 1 was 45.0 [40.0; 55.5]% vs 65.0 [60.0; 70.0]% in group 2 (P = 0.002) (CT lungs). In group 2 there is a higher value of CRP 52.5 [37.0; 78.0] mg/l vs 36.0 [27.0;43.0] mg/l (P = 0.016), ferritin value 545.0 [480.0; 550.0] ng/ml. vs 433.7 [420.0;580.0] ng/ml (P = 0.011). In groups 1 and 2, there were no significant differences in the indicators of erythrocytes and hemoglobin. There was a difference in the value of leukocytes 9.4 [9.0; 9.9]×10⁹/l vs 5,7 [4,7; 8,3] ×10⁹/l (P = 0.023), stab neutrophils 4.0 [3.0;5.0]% vs 7,0 [6,0; 10,0]% (P = 0.002) and lymphocyte count 16.0 [11.0;17.0]% vs 11.0 [10.0; 14.0]% (P = 0.013). An increase in HbA1c is associated with a decrease in SpO2 (r =-0.78), an increase in the percentage of lung tissue damage by CTlungs (r =0.66), CRP (r =0.67), ferritin (r =0.79), D-dimers(r =0.60) in group 1. A positive correlation was registered between the HbA1c values and the percentage of lung tissue damage by CT (r =0.87), CRP(r =0.96), D-dimer (r =0.93), ferritin (r =0.93); and a decrease in SpO2 is associated with an increase in HbA1c (r=-0.98), CTlungs (r =-0.98), CRP(r =-0.92), D-dimers (r =-0.89) in group 2.

Conclusions: Decompensation of diabetes mellitus in patients with COVID 19 is accompanied by an increased degree of damage to the lung tissue, prolonged oxygen therapy, increased values of CRP, D-dimers, ferritin, lymphopenia, and the lowest value of leukocytes.