Сarbohydrate metabolism disorders and their outcomes in the long-term period in hospitalized patients with COVID-19

Abstract

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients.AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it.MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose; HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters.RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of  carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%); 8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people).CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.