Type 2 diabetes mellitus and hyperglycemia among hospitalized COVID-19 patients: A single center study from Lebanon

Background The residual effects of coronavirus (CoV) disease 2019 (COVID-19) remains to this day as modern research continues to further investigate the disease. COVID-19 patients with diabetes mellitus (DM) seem to have a poorer prognosis overall. Lebanon's DM prevalence has been previously well described in the literature, and some studies have documented some of COVID-19's drastic morbidity and mortality in type 2 DM (T2DM) patients. As per our literature review, there has not been any study in Lebanon, which exclusively describes the state of T2DM and hyperglycemia among COVID-19 adult inpatients. Aim To describe T2DM and hyperglycemia in relation to selected patients' clinical characteristics, paraclinical data, and mortality outcomes of COVID-19 pneumonia among patients admitted to the Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), a large tertiary care medical center in Beirut, Lebanon. Methodology This was an observational retrospective study of COVID-19 patients admitted to LAUMC-RH over a near course of 8 months. The eligible subjects were hospitalized adult (≥18 years old) male and nonpregnant female patients with COVID-19 pneumonia. The total eligible sample was 484 patients. All analyses were evaluated at 0.05 significance level. Cross tabulation of the results was done along with odds ratio when applicable. Cross tabulation of the results was done along with odds ratio when applicable. Multivariate analysis, survival analysis, and cox regression were also performed. Results Among the admitted COVID-19 patients, 33.7 % had T2DM and 9.2 % of the DM patients had previously undiagnosed T2DM. Approximately 4.5 % of the COVID-19 patients had documented hypoglycemia, and 55 % had hyperglycemia. Comparing T2DM to non-T2DM patients, approximately 48.2 % of hypertension (HTN), 52.6 % of dyslipidemia (DL), and 58.9 % of coronary artery disease (CAD) COVID-19 patients had T2DM ( p -values <0.05). Around 69.6 % of patients who remained between 5 and 10 days in the intensive care unit (ICU) had T2DM (p-value <0.05). 36.8 % of the deceased inpatients had T2DM; however, the result was statistically insignificant. 55.3 % and 68.2 % of the patients with hyperglycemia and hypoglycemia, respectively, had T2DM ( p -values <0.05). Hyperglycemic emergencies occurred mostly in patients with T2DM (p-value <0.05), with intravenous (IV) insulin drip being used in 77.1 % among T2DM patients ( p -value <0.05). The mean glycated haemoglobin (HbA1c) for T2DM patients alone was 8.12 ± 1.68 %. Approximately 94.7 % of patients who had in-hospital hyperglycemia where on steroids (p-value <0.05). Patients with HTN, DL, CAD, overweight, and obesity all had T2DM and in-hospital hyperglycemia ( p -values <0.05). Patients on home sulfonylureas (SU) or metformin were more likely to survive post hospital discharge. Around 18.4 % of patients with hyperglycemia and 31.8 % of hypoglycemia patients died, and 100 % of the patients who had hyperosmolar hyperglycemic state passed away ( p -values <0.05). Most of the patients who were on steroids during hospitalization survived on discharge (p-value 0.02). Hyperglycemia, solely and with T2DM, was linked to unfavourable prognosis on discharge thus highlighting the importance of glycemic control in inpatient acute infectious states. Discussion and conclusion A dynamic pathophysiologic relationship between COVID-19 and the prominence of hyperglycemia exists. Generally, T2DM individuals are at more risk of infections due to exaggerated inflammatory reactions and lymphopenia. Worse mortality outcomes are witnessed among COVID-19 patients with a compromised cardiovascular profile, which would eventually influence the pulmonary function. Studies have contrasted the role of certain home anti-diabetes medications prior to the viral infection on the course of hospitalization; however, a majority of positive consensus seem to be present regarding the role of pre-hospitalization metformin. Steroids play a valuable role in improving COVID-19 morbidity and mortality; nevertheless, they should be used with caution in T2DM and non-T2DM patients given the risks of hyperglycemia. Adequate care is necessitated to fully control the metabolic disease profile of a COVID-19 patient.