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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai
Fatheya Alawadi, Alaaeldin Bashier, Azza Abdulaziz Bin Hussain, Nada Al-Hashmi, Fawzi Al Tayb Bachet, Mohamed Mahmoud Aly Hassanein, Marwan Abdelrahim Zidan, Rania Soued, Amar Hassan Khamis, Debasmita Mukhopadhyay, Fatima Abdul, Aya Osama, Fatima Sulaiman, Muhammad Hamed Farooqi, Riad Abdel Latif Bayoumi
Fatheya Alawadi, Alaaeldin Bashier, Azza Abdulaziz Bin Hussain, Nada Al-Hashmi, Fawzi Al Tayb Bachet, Mohamed Mahmoud Aly Hassanein, Department of Endocrinology, Dubai Academic Health Corporation, Dubai, United Arab Emirates
Marwan Abdelrahim Zidan, Department of Medical Education and Research, Dubai Academic Health Corporation, Dubai, United Arab Emirates
Rania Soued, Department of Radiology, Mediclinic City Hospital, Dubai, United Arab Emirates
Amar Hassan Khamis, Debasmita Mukhopadhyay, Fatima Abdul, Aya Osama, Fatima Sulaiman, College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
Muhammad Hamed Farooqi, Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, United Arab Emirates
Riad Abdel Latif Bayoumi, Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
Author contributions: Alawadi F, Bashier A, Bin Hussain AA, Al-Hashmi N, Bachet FAT, Hassanein MMA, Farooqi MH, Abdul F and Osama A contributed to patient recruitment; Zidan MA and Khamis AH contributed to statistics; Soued R contributed to radiology; Mukhopadhyay D and Sulaiman F contributed to Laboratory; Alawadi F, Khamis AH, Hassanein MMA and Bayoumi RAL contributed to write manuscript.
Institutional review board statement: The study was reviewed and approved by the Dubai Scientific Research Ethics Committee (DSREC) of the Dubai Health Authority (DHA), No. DSREC-05/2020-17 was issued on 28th May 2020.
Informed consent statement: Patients' informed consent was waived by DSREC as part of the policy to garner information about the COVID-19 pandemic. Therefore, patient consent was not obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Riad Abdel Latif Bayoumi, MBBS, PhD, Professor, Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai, United Arab Emirates.
riad.bayoumi@mbru.ac.ae
Received: March 28, 2023
Peer-review started: March 28, 2023
First decision: May 8, 2023
Revised: May 25, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 15, 2023
Processing time: 136 Days and 1.4 Hours
ARTICLE HIGHLIGHTS
Research background
Patients with diabetes suffer higher morbidity and mortality from corona virus disease 2019 (COVID-19). Despite better outcomes due to vaccination, many patients with diabetes continue to suffer from the disease. It is imperative therefore, to continue investigating the risk and predictors of COVID-19 severity in this vulnerable group, to help shaping better management of the disease.
Research motivation
Identifying independent predictors of mortality from COVID-19 will allow healthcare workers to prioritize vaccination, implement early management strategies for patients with COVID-19 and type 2 diabetes (T2D), and offset disease severity and mortality.
Research objectives
To identify independent mortality predictors among in-hospital patients with COVID-19 and T2D during the first wave of the pandemic (March–September 2020) in Dubai, United Arab Emirates.
Research methods
In this cross-sectional nested case-control study, a total of 1083 patients with COVID-19 were recruited. Of these, 427 had T2D and 656 were non-diabetic. The clinical, radiographic, and laboratory data of the patients with and without T2D were compared. Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.
Research results
Patients with T2D and COVID-19 were older and had a higher body mass index than patients without T2D. They had higher rates of comorbidities such as hypertension, ischemic heart disease, heart failure, and more life-threatening complications. All laboratory parameters of disease severity were significantly higher than in those without T2D. Therefore, these patients had a longer hospital stay and a significantly higher mortality rate. These patients died from COVID-19 at three times the rate of patients without T2D. In the univariate analysis of the independent predictors of mortality among all COVID-19 non-survivors, significant associations were identified with old age, increased white blood cell count, lymphopenia, and elevated serum troponin levels. In multivariate analysis, only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.
Research conclusions
It seems that the increased severity and mortality of patients with COVID-19 and T2D is due to older age and comorbidities such as hypertension, cardiovascular disease, chronic kidney disease, and obesity, with an added severe proinflammatory state.
Research perspectives
It is necessary to further investigate the factors that heighten the pro-inflammatory state, driving higher mortality among patients with T2D and COVID-19.
