Abstract
COVID-19 IN DIABETIC PATIENTS: A REVIEW OF COMORBIDITES AND WORSE OUTCOMES

Nabeel Hussain*, Subash Dulal, Febin Prince, Nouman Anthony, Arindaam Arjunrao Pol, Farzan Salehi, Nawal Rafiq, Ayesha Younus, Hanieh Akbariromani, Rupa Garikipati, Manel Bouchama, Dama Vishwak, Arvind Singh and Nidhi K. Patel

ABSTRACT

Introduction: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the first case being reported in Wuhan, China. The World Health Organization has declared this outbreak a global pandemic and social containment measures have been adopted worldwide. There is a high prevalence of concomitant conditions, including diabetes, cardiovascular disease, hypertension, obesity, and chronic obstructive pulmonary disease. Poor glyecemic control worsens outcomes for patients with COVID-19. Methodology: We systematically reviewed the literature on COVID-19 and its relevance to diabetes. A comprehensive literature search was performed using a combination of keywords (MeSH terms and free text words), including "COVID-19/SARS-CoV-2" and "diabetes/hyperglycemia." Pubmed, EMBASE, and Cochrane Library were searched up to October 10, 2020. After carefully reviewing the full length articles, 7 studies were included which showed the outcomes and prognostic factors of COVID-19 illness in diabetic patients. Results: Older age and male sex are epidemiological features related to a higher prevalence of COVID-19 and a more severe clinical course. Case fatality rate in diabetic patients was significantly higher than the non diabetic patients. Also poor prognosis was seen in Black, Asian, and mixed ethnicities compared with white people. Insulin infusion allowed achievement of glycemic targets and improved outcomes in patients with hyperglycemia with COVID-19. Metformin also showed promising outcomes in patients with diabetes. Conclusion: Diabetes was itself an independent risk factor for poor prognosis and worse outcomes in COVID-19 patients. A higher prevalence of cardiovascular risk factors such as hypertension, diabetes, and obesity in ethnic minorities than the white population might partly account for the increased risk of poor outcomes in these minority populations. Age is also one of the risk factor associated with worse outcomes. Antiviral therapy should be carefully tailored due to its interaction with the anti-diabetic agents.

Keywords: We systematically reviewed the literature on COVID-19 and its relevance to diabetes.


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