الفهرس 
Introduction and Aim of the study
Chapter 1 – COVID-19 overviewOnly 14 pages are availabe for public view
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Abstract
The emergence of SARS-CoV-2 resulted in the global COVID-19 pandemic. Its impact, particularly on vulnerable populations such as those with DM, has been a critical concern.
The recent pandemic has notably impacted diabetic patients, especially those with uncontrolled diabetes.
This prospective cohort study aimed to investigate and analyse the relationship between diabetes and various clinical outcomes of COVID-19 in hospitalized patients. Specifically, it sought to understand how diabetes affected symptomatology, physiological parameters, disease severity, and mortality rates in COVID-19 cases.
The study enrolled a total of 160 COVID-19 patients, comprising two primary groups categorized based on their HbA1c levels. The diabetic group consisted of 80 individuals (50%) with HbA1c levels ≥ 6.5%, while the non-diabetic group included 80 individuals (50%) with HbA1c levels ≤ 6.4%.
A significant difference in the age distribution was observed, with the DM patients exhibiting a higher mean age (63.35 years ± 11.63) compared to the non-DM group (54.53 years ± 16.03) (P<0.001). Gender disparities were evident, with a higher proportion of females infected (55%) compared to males (45%) (P=0.002). The occurrence of chronic diseases did not significantly differ between the groups (P=0.268).
There were notable differences in COVID-19 symptoms. Anosmia was more prevalent in the non-diabetic patients (22.5%) compared to the diabetic patients (8.8%) (P<0.028). Headaches were significantly more frequent in diabetic patients (42.5%) than non-diabetic individuals (26.3%) (P=0.045). Also, diabetic patients showed higher rates of dyspnoea (92.5%) compared to non-diabetics (80%).
Regarding physiological parameters, the diabetic patients presented higher respiratory rates (33 ± 5) compared to non-diabetic patients (29 ± 5) (P<0.001). Diabetic patients exhibited lower oxygen saturation levels (78.05 ± 6.35) compared to non-diabetic counterparts (80.34 ± 6.76) (P<0.007) and required more oxygen treatment (88.8%) compared to non-diabetic individuals (71.3%). The diabetic patients exhibited higher systolic and diastolic blood pressure, increased urea levels, altered liver enzymes (AST and ALT), and differences in key blood parameters like sodium levels, D-dimer, CRP, LDH, and serum ferritin.
Further distinctions were observed in the severity and clinical outcomes between diabetic and non-diabetic patients. Diabetic patients had a higher proportion of critical COVID-19 cases (89.6% vs. 57.7%) and experienced more complications, including hypoalbuminemia, hypoglycemia, shock, and Diabetic Ketoacidosis (DKA). ICU admissions were notably higher among diabetic patients (43.8%) compared to non-diabetics (17.5%), with prolonged ICU stays.
Regarding mortality rates, known diabetics exhibiting the highest mortality (46.9%), followed by newly-discovered diabetics (39.6%), pre-diabetics (25%), and normoglycemic patients (19.2%).
Regression analyses revealed that diabetes was a significant predictor for ICU admission, severity of COVID-19 cases, and increased mortality risk.
The Kaplan-Meier analysis highlighted significant differences in survival rates between studied subgroups, indicating the non-diabetic subgroup’s higher survival rate over time compared to the other subgroups.