Course of coronavirus infection in patients with type 2 diabetes mellitus

The coronavirus infection (COVID-19) pandemic remains a hot topic of study to this day. According to studies, mortality in patients with COVID-19 and a history of diabetes mellitus (DM) is 2-3 times higher than in patients without DM.

The purpose of the study is to analyze the course of coronavirus infection in patients with T2DM.

Material and methods: A prospective observation of 381 patients with T2DM and COVID-19 in the intensive care unit was carried out in 2020-2021. 2 groups were formed: Group I (comparison group) – patients with a fatal outcome, Group II (control group) – patients discharged from the hospital with an improvement in their condition. An assessment was made of changes in the dynamics of clinical and laboratory parameters upon admission and before discharge in both groups.

Results and discussion: Patients with a fatal outcome were more often admitted in a serious condition (75% vs. 12.7% at p ≤ 0.0001). Significantly more often than aches (92.5% vs. 69.58%, p=0.0044), shortness of breath on exertion (92.5% vs. 75.17%, p=0.0245), grade 3 DN (62.5%, p<0.0001), the need for non-invasive lung ventilation (28.95% versus 1.39%, p <0.0001) artificial lung ventilation (81.1% versus 1.75% ( p<0.0001) was noted in group I. In the comparison group, the Charlson comorbidity index was higher: 6.0 [5.0;7.0] versus 4 [4; 4], at p<0.0001. In the group of patients who were discharged with improvement, they more often took metformin and sulfonylureas, in the group of patients who died, they were more often on insulin therapy. In dynamics, the levels of intracellular enzymes such as alkaline phosphatase, creatine phosphokinase, lactate dehydrogenase in the group with an unfavorable outcome significantly increased, in contrast to the group with a positive outcome. Also, in a fatal outcome, there is a deterioration in kidney function, laboratory characterized by an increase in the level of creatinine and urea, a decrease in the glomerular filtration rate and blood albumin. Despite the ongoing anticoagulant therapy, patients with a fatal outcome showed pronounced signs of activation of the hemostasis system, which are characterized by an increase in INR, prolongation of prothrombin time and aPTT, and thrombocytopenia.

Conclusion.  The risk of death from coronavirus infection in people with diabetes increases with age. DM 2 is a comorbid disease and acute multiple organ disorders develop with the addition of a coronavirus infection. Coronavirus-induced coagulopathy in patients with DM2 and COVID-19 with a fatal outcome is characterized by poor controllability and low efficacy of anticoagulant therapy.

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