Endocrine Abstracts

Introduction: Type 2 diabetes is one of the main risk factors for severe COVID 19 infection. Inadequate glycemic control is related to high inflammation, hypercoagulability, and mortality in COVID-19 patients. Glucose lowering medications commonly used to treat diabetes mellitus (DM) might have effects on COVID 19 pathogenesis. Overall, evidence is conflicting as to which glucose-lowering drugs are associated with the most favourable outcomes in patients with COVID-19. The aim of our study was to evaluate association of COVID-19 severity with different types of DM therapy.

Patients and Methods: CThe retrospective study included 95 patients with type 2 DM and COVID 19: 25 (26.9%) received metformin, 16 (16.8%) metformin and sulfonureas, 12 (12.7%) metformin and dipeptidyl peptidase type 4 inhibitors (DPP-4), 8 (8.5%) metformin and glucagon-like peptide receptor agonists (GLP-1 RA), 13 (13.8%) metformin and basal insulin, 10 (9.5%) premix insulin and 11 (11.8%) basal and bolus insulin. Clinical presentation, ICU admission and death rate has been compared in patients with different types of DM therapy.

Results: Clinical presentation was mild in patients with metformin, metformin and DPP-4, metformin and GLP-1 RA and more pronounced in patients with premix insulin and basal bolus insulin. The three most common symptoms were: fever, cough and fatigue. Glycemic at admission were highest in patients with premix insulin (13.6±4.58 mmol/l), and the lowest in patients with metformin and DPP-4 (7.5±4.23 mmol/l). Our studies showed that inflammatory response and ICU admission rate were the highest in patients with premix insulin therapy and the lowest in metformin group (12.3 vs 7.1%). A total of 16 patients died (16.8 %) during hospitalization. The highest rate was in patient who received premix insulin 6 (50%) and the lowest in patients who received metformin 2 (2.1%).

Conclusion: Our results had showed that therapy with premix and basal bolus insulin had link with severe clinical presentation, ICU admission and death.

Key words: COVID 19, type 2 diabetes mellitus, metformin, insulin