The relationship between diabetes and the severity of COVID-19

The relationship between diabetes and the severity of COVID-19 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between diabetes and the severity of COVID-19 Hussam Khaled Abobaker, Abdalrhman Mhd Ali Abozraa, Hussam Al-Bardan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2062588/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background A new viral disease called coronavirus disease 2019 (COVID-19) originally surfaced in Wuhan, China, and has swiftly spread throughout the globe. We sought to comprehend how COVID-19's prognosis related to diabetes mellitus. Methods This is a retrospective, single-center cohort research conducted at Damascus Hospital from December 25, 2020 to March 20, 2021, 365 COVID-19 patients were enrolled. Data on demographics, clinical characteristics, laboratories, radiologic findings, therapies, complications, and clinical outcomes were taken from medical records and compared between groups with and without diabetes (n = 195 and n = 170). Results Out of 365 COVID-19 patients that were involved in the trial, 207 (57%) were men and 158 (43%) were women. Patients participating in COVID-19 were divided into two groups: those with diabetes (n = 195) and those without the condition (n = 170). Patients with diabetes had higher rates of symptoms such as fatigue (86.7%, P = 0.000), dyspnea (93.8%, P = 0.000), headache (32.8%, P = 0.000), and chest discomfort (8.2%, P = 0.000). We found that those with uncontrolled diabetes who were coronavirus-infected had a significant mortality rate, with a death rate of 64% in this group of patients. Conclusion The prognosis of COVID-19 is independently at risk due to diabetes. Patients with diabetes, especially those who require insulin therapy, should get more focus on prevention and treatment. Pulmonology Infectious Diseases Diabetes COVID-19 symptoms Damascus hospital Introduction: The coronavirus SARS-CoV-2 that causes COVID-19 is a fast-moving, infectious illness that affects most nations in the world [ 1 ]. After the Middle East respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV), SARS-CoV-2 is the third coronavirus to occur in human history [ 2 , 3 ]. The coronavirus group of enveloped viruses is called after the crown-like shape of their virions when seen under an electron microscope. They are encoded by single-stranded positive-sense RNA genomes. The primary characteristic of SARS-CoV-2 that sets it apart from other viruses is its ability to spread, together with a higher risk of fatality brought on by acute respiratory distress syndrome (ARDS). SARS-CoV-2 infections can cause a variety of signs and symptoms, from mild or asymptomatic infections that are limited to the upper respiratory tract (20–86% of all infections) to drastic respiratory distress caused by the infection spreading to the lower airways and causing localized inflammation and pneumonia. Patients who have concomitant conditions such as chronic obstructive pulmonary disease (COPD), asthma, diabetes, hypertension, and cardiovascular disease (CVD) are more likely to experience this [ 4 , 5 ]. Significantly, Maddaloni et al. hypothesized that Covid-19 patients with diabetes had higher rates of COPD and chronic kidney disease (CKD) [ 6 ]. In general, people with diabetes and/or obesity have impaired innate and adaptive immune responses, which are characterized by a state of persistent low-grade inflammation [ 7 ], that can cause an abrupt change in systemic metabolism that is indicated by higher levels of leptin (a proinflammatory adipokine) and lower levels of adiponectin (an anti-inflammatory adipokine) [ 8 , 9 ]. Prior research revealed that people with diabetes were at a higher risk of both SARS and MERS [ 10 , 11 ]. It has been demonstrated that histories of diabetes and hyperglycemia among SARS patients are independent predictors of death and morbidity, and that metabolic management could enhance their prognosis [ 11 ]. In addition, hyperglycemia is a potent predictive indicator of outcome in COVID-19 hospitalized patients. Previous research has shown that COVID-19 hyperglycemic patients had a greater cumulative incidence of severe illness than normoglycemic groups [ 12 , 13 ]. Alternative explanations for this higher mortality include immune system alterations brought on by hyperglycemia and an increase in inflammatory cytokines [ 14 ]. Additionally, 26.8% of older people who were more likely to die from COVID-19 had diabetes [ 4 ]. 10.5% of the population in the United States has diabetes [ 4 ]. Similar to this, obese people are more likely to get SARS-CoV-2 problems [ 15 , 16 ]. The prognosis and disease progression of 365 COVID-19 patients were examined to determine whether diabetic COVID-19 patients have a poorer disease progression. Demographic, clinical, laboratory, radiologic, therapy, complications, and clinical outcome data were meticulously collected and analyzed. Materials And Methods: Study Design and Participants We included 365 COVID-19 patients in this retrospective, single-center cohort study from December 25, 2020, to March 20, 2021, at Damascus Hospital, which was also the designated hospital for the treatment of COVID-19. The Declaration of Helsinki's standards are followed in all research methods. Data Collection From the patients' medical records, we collected all the information, including demographic, clinical, laboratory, radiological, and treatment-related variables as well as complications and clinical outcomes. On March 30, 2021, all patients were followed up with. All patients had throat swabs taken from their upper respiratory tracts, which were then examined using either next-generation sequencing technology or reverse transcription polymerase chain reaction to determine whether they had SARS-CoV-2 infection. Definition One of the following criteria must be met in order to diagnose diabetes mellitus: In a glucose tolerance test, the following criteria must be met [17]: 1) Fasting plasma glucose levels ≥7.0 mmol/L; 2) Plasma glucose levels ≥11.1 mmol/L two hours later; 3) Casual plasma glucose levels ≥11.1 mmol/L; and 4) Glycated hemoglobin (HbA1c) levels ≥48 mmol/mol. A temperature in the axilla more than 37.3 °C was considered fever. Critical illness was indicated in the assessment of disease severity if it met at least one of the following criteria: 1) Respiratory failure necessitating the use of artificial respiration; 2) shock performance 3) Multiple organ failure necessitating intensive care unit (ICU) observation. A low arterial partial pressure of oxygen (PaO2) has been characterized as respiratory failure. Acute liver injury was defined as an increase in alanine aminotransferase to more than three times the upper limit of the reference, an increase in aspartate aminotransferase to more than three times the upper limit of the reference, or an increase in total bilirubin to more than two times the upper limit of the reference, regardless of liver comorbidities [18] Statistical Analysis Our study's statistical analysis was completed using SPSS Version 27 for Windows (IBM Corp., Armonk, NY, USA). 5% was chosen as the degree of significance. For continuous variables, means and standard deviations (SDs) were used to describe the sample's characteristics, while for categorical variables, frequencies and percentages were used. The means of the two groups were compared using an independent sample t-test for continuous variables, and for categorical data, we compared variables between the diabetes and nondiabetics groups using the chi-squared test or Fisher's exact test. Results: Out of 365 COVID-19 patients involved in the study, 207 (57%) were men and 158 (43%) were women. Patients varied in age from 25 to 75, with the 51 to 75 age group accounting for the biggest percentage of participants. 190 individuals (or 97% of them) have type 2 diabetes, which has been diagnosed in the majority of patients (53%). More than half of them have had the disease for a long time. (Table 1 ). Table 1 sociodemographic characteristics. Gender N (%) Male 207 (57) Female 158 (43) Age 75 73 (20) Diabetes Yes 195 (53) No 170 (47) Type of diabetes Type 1 5 (3) Type 2 190 (97) Diabetes diagnosing time Newly diagnosed 72 (37) Old diagnosed 123 (63) Smoking Yes 137 (38) No 228 (62) According to Table 2 , COVID-19 patients were split into two groups: those with diabetes (n = 195) and those without the disease (n = 170). Symptoms including fatigue (86.7%, P = 0.000), dyspnea (93.8%, P = 0.000), headache (32.8%, P = 0.000), and chest pain (8.2%, P = 0.000) were more prevalent in diabetic patients. Table 2 Clinical characteristics between COVID-19 patients with and without diabetes. Symptoms Diabetes P value Yes No Fever 162 (83) 57 (34) 0.000* Dyspnea 183 (93.8) 55 (32.4) 0.000* Fatigue 169 (86.7) 44 (25.9) 0.000* Cough 149 (76) 57 (34) 0.000* Myalgia 97 (49.7) 29 (17.1) 0.000* Nausea and vomiting 77 (39.5) 31 (18.2) 0.000* Headache 64 (32.8) 17 (10) 0.000* Chest pain 16 (8.2) 3 (1.8) 0.000* Pharyngalgia 39 (20) 12 (7.1) 0.000* Studying the association between diabetes in Corona patients and the presence of various complications arising from this injury, we discovered relationships with strong statistical implications, such as an increase in the incidence of respiratory failure in diabetic patients by 44% when compared to patients without diabetes, where the p value was 0.0001. Additionally, we discovered a link between diabetes mellitus and the development of acute renal damage in COVID patients. Diabetic individuals had a 19% prevalence of this mixing, compared to non-diabetic patients. (Table 3). Table 3: Complication between COVID-19 patients with and without diabetes. Complications Diabetes P value Yes No Respiratory failure 86 (44.1) 20 (11.8) 0.000* Acute cardiac injury 15 (7.7) 20 (11.8) 0.187 Acute kidney injury 37 (19) 5 (2.9) 0.000* Diabetic keto acidosis 30 (15.4) 0 (0%) 0.000* *Statistically significant We split diabetics into three groups, with the first group consisting of diabetic patients with good glycemic control; the second group included diabetic patients with uncontrolled glucose levels; and the third group included non-diabetic individuals. We discovered that people with uncontrolled diabetes who were infected with the coronavirus had a high mortality rate, with a death rate of 64% in this group of patients. In contrast, non-diabetic corona patients had the highest recovery rates, with a survival rate of 55% of all patients, with a P value of 0.018. (Table 4). Table 4: Clinical outcome between COVID-19 patients with and without diabetes. Diabetes Clinical outcome P value Death alive Yes/Controlled diabetes 57 (46) 66 (54) 0.018* Yes/Uncontrolled diabetes 46 (64) 26 (36) No 76 (45) 94 (55) *Statistically significant When categorizing the severity of the condition in Corona patients into mild, medium, severe, and critical categories, we discovered a statistically significant correlation between the increase in severity of the condition in patients who are not controlled with diabetes and the percentage of patients who have a critical condition and have uncontrolled sugar reaching 51%. (Table 5). Table 5: Relationship between diabetes and the severity of the condition. Severity assessment Diabetes P value Controlled diabetes Uncontrolled diabetes No Mild 14 (11) 3 (4) 14 (8) 0.216 Moderate 46 (37) 7 (10) 79 (47) 0.000* Severe 6 (5) 25 (35) 5 (3) 0.000* Critical 57 (46) 37 (51) 72 (42) 0.423 *Statistically significant Discussion: The response of our body to pathogens can be impacted by the chronic inflammatory condition known as diabetes mellitus, which is characterized by several macrovascular and microvascular abnormalities [ 19 ]. Clinicians have long been concerned about the link between diabetes and infection. Elderly diabetes people frequently get infectious infections, including the flu and pneumonia. Additionally, prior research has demonstrated that diabetes is a risk factor for the morbidity and mortality of other viral infections, including 2009 influenza A (H1N1), MERS-CoV, and SARS-CoV [ 11 , 20 , 21 ]. However, the association between diabetes and COVID-19 prognosis is infrequently documented. We examined data from 365 COVID-19 patients in this retrospective cohort analysis, comprising 195 instances of diabetes and 170 cases of no diabetes. Our study's observations of elevated mortality risk in COVID-DM patients were consistent with results from earlier meta-analyses [ 22 ]. There are a variety of ways in which DM could make COVID-19 patients more susceptible to death. This study demonstrates that the majority of people with diabetes mellitus (DM) in Syria have cardiometabolic comorbidities and chronic diabetic sequelae, which is partially attributable to the larger percentage of DM patients who receive a late diagnosis [ 23 – 25 ]. However, despite the considerable reduction following the correction for severe cardiometabolic comorbidities, the link between DM and COVID-19 mortality remained significant, indicating alternative mechanisms may be involved. Aging cells, a stronger pro-inflammatory state, poorer T-cell activity, and decreased antibody production are only a few of the mechanisms that have been identified to be involved [ 22 ]. It is significant to note that our study found that patients with DM were more likely to present with clinical symptoms than non-DM patients. We assessed the severity of each patient's illness in accordance with the criteria outlined in the methods, and we discovered that there were more critically ill patients in the diabetes group, which may indicate that diabetic patients are more likely to develop a severe condition after contracting SARS-CoV-2. These results are consistent with earlier research showing that DM raises the risk of developing a severe COVID-19 infection [ 22 , 26 ]. Our results, however, differed from those of a prior study, which found that both the DM group and the non-DM group experienced identical COVID-19 pneumonia symptoms [ 27 ]. It is crucial to note that additional factors, such as the limited experience during the early pandemic and the restricted availability of healthcare facilities, might also be a factor in the higher mortality [ 28 ]. These results can also indicate that there is still potential for improvement in Syrian's COVID-19 management. Our study has a number of drawbacks. Firstly, this retrospective cohort study has a selection bias, and further prospective investigations are required. Second, to confirm our findings, more extensive multicenter research must be conducted as our research is solely based on a single-center study. Conclusion: In conclusion, our analysis provided evidence that COVID-DM patients were more likely to experience clinical symptoms, in addition to confirming earlier reports that DM is independently related to a greater risk of COVID-19 death. Declarations Acknowledgments: We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We are thankful to everyone who participated in this study. Funding: This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Declarations: Ethics approval and consent to participate: This study was approved by the Institutional Review Board (IRB) at the Syrian Private University (SPU). All Participants confirmed their written consent by signing the consent form. Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential. Consent for Publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Authors’ contributions: HA and AA were responsible for study design, literature search, and write-up; HA was responsible for data analysis; AA participated in literature search and write-up; HB participated in the study design and reviewed the final draft. All authors read and approved the final draft. References 1. Walls, A.C., et al., Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell, 2020. 181 (2): p. 281-292.e6. 2. Zhou, J., et al., Middle East respiratory syndrome coronavirus infection: virus-host cell interactions and implications on pathogenesis. Virol J, 2015. 12 : p. 218. 3. Chan, J.F., et al., Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev, 2015. 28 (2): p. 465-522. 4. Muniyappa, R. and S. Gubbi, COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab, 2020. 318 (5): p. E736-e741. 5. Li, B., et al., Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol, 2020. 109 (5): p. 531-538. 6. Maddaloni, E., et al., Clinical features of patients with type 2 diabetes with and without Covid-19: A case control study (CoViDiab I). Diabetes Res Clin Pract, 2020. 169 : p. 108454. 7. Andersen, C.J., K.E. Murphy, and M.L. Fernandez, Impact of Obesity and Metabolic Syndrome on Immunity. Adv Nutr, 2016. 7 (1): p. 66-75. 8. Francisco, V., et al., Adipokines: Linking metabolic syndrome, the immune system, and arthritic diseases. Biochem Pharmacol, 2019. 165 : p. 196-206. 9. Faber, D.R., P.G. de Groot, and F.L. Visseren, Role of adipose tissue in haemostasis, coagulation and fibrinolysis. Obes Rev, 2009. 10 (5): p. 554-63. 10. Kulcsar, K.A., et al., Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight, 2019. 4 (20). 11. Yang, J.K., et al., Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med, 2006. 23 (6): p. 623-8. 12. Sardu, C., et al., Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control? Diabetes Care, 2020. 43 (7): p. 1408-1415. 13. Sardu, C., et al., Hyperglycaemia on admission to hospital and COVID-19. Diabetologia, 2020. 63 (11): p. 2486-2487. 14. Schuetz, P., P. Castro, and N.I. Shapiro, Diabetes and sepsis: preclinical findings and clinical relevance. Diabetes Care, 2011. 34 (3): p. 771-8. 15. Drucker, D.J., Coronavirus Infections and Type 2 Diabetes-Shared Pathways with Therapeutic Implications. Endocr Rev, 2020. 41 (3). 16. Ryan, D.H., E. Ravussin, and S. Heymsfield, COVID 19 and the Patient with Obesity - The Editors Speak Out. Obesity (Silver Spring), 2020. 28 (5): p. 847. 17. Alberti, K.G. and P.Z. Zimmet, Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998. 15 (7): p. 539-53. 18. [The protocol for prevention, diagnosis and treatment of liver injury in coronavirus disease 2019]. Zhonghua Gan Zang Bing Za Zhi, 2020. 28 (3): p. 217-221. 19. Knapp, S., Diabetes and infection: is there a link?--A mini-review. Gerontology, 2013. 59 (2): p. 99-104. 20. Schoen, K., et al., Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity. BMC Infect Dis, 2019. 19 (1): p. 964. 21. Banik, G.R., et al., Risk factors for severity and mortality in patients with MERS-CoV: Analysis of publicly available data from Saudi Arabia. Virol Sin, 2016. 31 (1): p. 81-4. 22. Huang, I., M.A. Lim, and R. Pranata, Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr, 2020. 14 (4): p. 395-403. 23. Soewondo, P., A. Ferrario, and D.L. Tahapary, Challenges in diabetes management in Indonesia: a literature review. Global Health, 2013. 9 : p. 63. 24. Tahapary, D.L. and P. Soewondo, Burden of metabolic diseases in Indonesia: an even more critical issue during COVID-19 pandemic. Medical Journal of Indonesia, 2020. 29 (4): p. 347-9. 25. Suastika, K., The challenges of metabolic disorders in Indonesia: focus on metabolic syndrome, prediabetes, and diabetes. Medical Journal of Indonesia, 2020. 29 (4): p. 350-3. 26. Peric, S. and T.M. Stulnig, Diabetes and COVID-19 : Disease-Management-People. Wien Klin Wochenschr, 2020. 132 (13-14): p. 356-361. 27. Li, G., et al., Clinical Characteristics of Diabetic Patients with COVID-19. J Diabetes Res, 2020. 2020 : p. 1652403. 28. Walker, P.G.T., et al., The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science, 2020. 369 (6502): p. 413-422. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2062588","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":136466876,"identity":"c7f48a2d-04a7-4014-bf27-a15835b52e1d","order_by":0,"name":"Hussam Khaled Abobaker","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBACgwMQOoFBgoEZSNvI8YO5BcRrSTOWbABxDYjXcjhxA1gEn5Yb6Y8//Myxy+OXbn5s8HHPYWPj86sTPzwwYJDnFzuAVYv9jRwzyd5tycWSc44ZJ854li5nduPtZgmgwwxnzk7AYUsOGwPvNubEDTcSjA/zHLA2NrtxdgNIS4LBbVxa0h9//LutHqgl/fPhPweYEzfPOLv5B34tCQbSvNuAvr6RY5zMcMA5cQN/7zb8tpx5YyYtu+040C9nig17DqQZS9zg3WaRYCCB2y/HgQ57u60aGGLtmyV+HABGZf/ZzTd/VNjI80tj14IFSIBVShCrHAT4D5CiehSMglEwCkYAAAC5/mvtvT3tuwAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of medicine, Syrian Private University","correspondingAuthor":true,"prefix":"","firstName":"Hussam","middleName":"Khaled","lastName":"Abobaker","suffix":""},{"id":136466877,"identity":"43d1f9c8-08ef-47e6-8128-eabc78556205","order_by":1,"name":"Abdalrhman Mhd Ali Abozraa","email":"","orcid":"","institution":"Faculty of medicine, Syrian Private University","correspondingAuthor":false,"prefix":"","firstName":"Abdalrhman","middleName":"Mhd Ali","lastName":"Abozraa","suffix":""},{"id":136466878,"identity":"cef2765b-a863-490e-8d7b-ebafea619801","order_by":2,"name":"Hussam Al-Bardan","email":"","orcid":"","institution":"Department of Internal medicine, Faculty of Medicine, Syrian Private University","correspondingAuthor":false,"prefix":"","firstName":"Hussam","middleName":"","lastName":"Al-Bardan","suffix":""}],"badges":[],"createdAt":"2022-09-13 22:44:38","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-2062588/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2062588/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":26582761,"identity":"fe83ccc8-b67d-49ea-b94a-d8a9b1c9aeeb","added_by":"auto","created_at":"2022-09-16 21:01:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":409828,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2062588/v1/e318bd5a-a741-4e58-b527-79fcae66e799.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe relationship between diabetes and the severity of COVID-19\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction:","content":"\u003cp\u003eThe coronavirus SARS-CoV-2 that causes COVID-19 is a fast-moving, infectious illness that affects most nations in the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. After the Middle East respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV), SARS-CoV-2 is the third coronavirus to occur in human history [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The coronavirus group of enveloped viruses is called after the crown-like shape of their virions when seen under an electron microscope. They are encoded by single-stranded positive-sense RNA genomes. The primary characteristic of SARS-CoV-2 that sets it apart from other viruses is its ability to spread, together with a higher risk of fatality brought on by acute respiratory distress syndrome (ARDS). SARS-CoV-2 infections can cause a variety of signs and symptoms, from mild or asymptomatic infections that are limited to the upper respiratory tract (20\u0026ndash;86% of all infections) to drastic respiratory distress caused by the infection spreading to the lower airways and causing localized inflammation and pneumonia. Patients who have concomitant conditions such as chronic obstructive pulmonary disease (COPD), asthma, diabetes, hypertension, and cardiovascular disease (CVD) are more likely to experience this [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Significantly, Maddaloni et al. hypothesized that Covid-19 patients with diabetes had higher rates of COPD and chronic kidney disease (CKD) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn general, people with diabetes and/or obesity have impaired innate and adaptive immune responses, which are characterized by a state of persistent low-grade inflammation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], that can cause an abrupt change in systemic metabolism that is indicated by higher levels of leptin (a proinflammatory adipokine) and lower levels of adiponectin (an anti-inflammatory adipokine) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Prior research revealed that people with diabetes were at a higher risk of both SARS and MERS [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It has been demonstrated that histories of diabetes and hyperglycemia among SARS patients are independent predictors of death and morbidity, and that metabolic management could enhance their prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, hyperglycemia is a potent predictive indicator of outcome in COVID-19 hospitalized patients. Previous research has shown that COVID-19 hyperglycemic patients had a greater cumulative incidence of severe illness than normoglycemic groups [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Alternative explanations for this higher mortality include immune system alterations brought on by hyperglycemia and an increase in inflammatory cytokines [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, 26.8% of older people who were more likely to die from COVID-19 had diabetes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. 10.5% of the population in the United States has diabetes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similar to this, obese people are more likely to get SARS-CoV-2 problems [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prognosis and disease progression of 365 COVID-19 patients were examined to determine whether diabetic COVID-19 patients have a poorer disease progression. Demographic, clinical, laboratory, radiologic, therapy, complications, and clinical outcome data were meticulously collected and analyzed.\u003c/p\u003e"},{"header":"Materials And Methods:","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included 365 COVID-19 patients in this retrospective, single-center cohort study from December 25, 2020, to March 20, 2021, at Damascus Hospital, which was also the designated hospital for the treatment of COVID-19. The Declaration of Helsinki\u0026apos;s standards are followed in all research methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the patients\u0026apos; medical records, we collected all the information, including demographic, clinical, laboratory, radiological, and treatment-related variables as well as complications and clinical outcomes. On March 30, 2021, all patients were followed up with. All patients had throat swabs taken from their upper respiratory tracts, which were then examined using either next-generation sequencing technology or reverse transcription polymerase chain reaction to determine whether they had SARS-CoV-2 infection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the following criteria must be met in order to diagnose diabetes mellitus: In a glucose tolerance test, the following criteria must be met\u0026nbsp;[17]: 1) Fasting plasma glucose levels \u0026ge;7.0 mmol/L; 2) Plasma glucose levels \u0026ge;11.1 mmol/L two hours later; 3) Casual plasma glucose levels \u0026ge;11.1 mmol/L; and 4) Glycated hemoglobin (HbA1c) levels \u0026nbsp;\u0026ge;48 mmol/mol. A temperature in the axilla more than 37.3 \u0026deg;C was considered fever. Critical illness was indicated in the assessment of disease severity if it met at least one of the following criteria: 1) Respiratory failure necessitating the use of artificial respiration; 2) shock performance 3) Multiple organ failure necessitating intensive care unit (ICU) observation. A low arterial partial pressure of oxygen (PaO2) has been characterized as respiratory failure. Acute liver injury was defined as an increase in alanine aminotransferase to more than three times the upper limit of the reference, an increase in aspartate aminotransferase to more than three times the upper limit of the reference, or an increase in total bilirubin to more than two times the upper limit of the reference, regardless of liver comorbidities\u0026nbsp;[18]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study\u0026apos;s statistical analysis was completed using SPSS Version 27 for Windows (IBM Corp., Armonk, NY, USA). 5% was chosen as the degree of significance. For continuous variables, means and standard deviations (SDs) were used to describe the sample\u0026apos;s characteristics, while for categorical variables, frequencies and percentages were used. The means of the two groups were compared using an independent sample t-test for continuous variables, and for categorical data, we compared variables between the diabetes and nondiabetics groups using the chi-squared test or Fisher\u0026apos;s exact test.\u003c/p\u003e"},{"header":"Results:","content":"\u003cp\u003eOut of 365 COVID-19 patients involved in the study, 207 (57%) were men and 158 (43%) were women. Patients varied in age from 25 to 75, with the 51 to 75 age group accounting for the biggest percentage of participants. 190 individuals (or 97% of them) have type 2 diabetes, which has been diagnosed in the majority of patients (53%). More than half of them have had the disease for a long time. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003esociodemographic characteristics.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e207 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u0026ndash;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e170 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes diagnosing time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNewly diagnosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOld diagnosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e228 (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, COVID-19 patients were split into two groups: those with diabetes (n\u0026thinsp;=\u0026thinsp;195) and those without the disease (n\u0026thinsp;=\u0026thinsp;170). Symptoms including fatigue (86.7%, P\u0026thinsp;=\u0026thinsp;0.000), dyspnea (93.8%, P\u0026thinsp;=\u0026thinsp;0.000), headache (32.8%, P\u0026thinsp;=\u0026thinsp;0.000), and chest pain (8.2%, P\u0026thinsp;=\u0026thinsp;0.000) were more prevalent in diabetic patients.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical characteristics between COVID-19 patients with and without diabetes.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSymptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162 (83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDyspnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e149 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMyalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNausea and vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChest pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharyngalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eStudying the association between diabetes in Corona patients and the presence of various complications arising from this injury, we discovered relationships with strong statistical implications, such as an increase in the incidence of respiratory failure in diabetic patients by 44% when compared to patients without diabetes, where the p value was 0.0001. Additionally, we discovered a link between diabetes mellitus and the development of acute renal damage in COVID patients. Diabetic individuals had a 19% prevalence of this mixing, compared to non-diabetic patients. (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e \u003cstrong\u003eComplication\u003c/strong\u003e \u003cstrong\u003ebetween COVID-19 patients with and without diabetes.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eRespiratory failure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e86 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e20 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eAcute cardiac injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e15 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e20 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eAcute kidney injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e37 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e5 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eDiabetic keto acidosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e30 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*Statistically significant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe split diabetics into three groups, with the first group consisting of diabetic patients with good glycemic control; the second group included diabetic patients with uncontrolled glucose levels; and the third group included non-diabetic individuals.\u0026nbsp;We discovered that people with uncontrolled diabetes who were infected with the coronavirus had a high mortality rate, with a death rate of 64% in this group of patients. In contrast, non-diabetic corona patients had the highest recovery rates, with a survival rate of 55% of all patients, with a P value of 0.018. (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Clinical outcome between\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCOVID-19 patients with and without diabetes.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"45.19230769230769%\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"51.06382978723404%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"48.93617021276596%\"\u003e\n \u003cp\u003e\u003cstrong\u003ealive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.807692307692307%\"\u003e\n \u003cp\u003eYes/Controlled diabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e57 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e66 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"39.743589743589745%\"\u003e\n \u003cp\u003eYes/Uncontrolled diabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.76923076923077%\"\u003e\n \u003cp\u003e46 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.487179487179485%\"\u003e\n \u003cp\u003e26 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"39.743589743589745%\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.76923076923077%\"\u003e\n \u003cp\u003e76 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.487179487179485%\"\u003e\n \u003cp\u003e94 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*Statistically significant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen categorizing the severity of the condition in Corona patients into mild, medium, severe, and critical categories, we discovered a statistically significant correlation between the increase in severity of the condition in patients who are not controlled with diabetes and the percentage of patients who have a critical condition and have uncontrolled sugar reaching 51%. (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Relationship between diabetes and the severity of the condition.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeverity assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"52.88461538461539%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.54545454545455%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControlled diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"36.36363636363637%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUncontrolled diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.09090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e14 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.23076923076923%\"\u003e\n \u003cp\u003e3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.384615384615385%\"\u003e\n \u003cp\u003e14 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e46 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.23076923076923%\"\u003e\n \u003cp\u003e7 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.384615384615385%\"\u003e\n \u003cp\u003e79 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.23076923076923%\"\u003e\n \u003cp\u003e25 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.384615384615385%\"\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.846153846153847%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCritical\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e57 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.23076923076923%\"\u003e\n \u003cp\u003e37 (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.384615384615385%\"\u003e\n \u003cp\u003e72 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.26923076923077%\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*Statistically significant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion:","content":"\u003cp\u003eThe response of our body to pathogens can be impacted by the chronic inflammatory condition known as diabetes mellitus, which is characterized by several macrovascular and microvascular abnormalities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Clinicians have long been concerned about the link between diabetes and infection. Elderly diabetes people frequently get infectious infections, including the flu and pneumonia. Additionally, prior research has demonstrated that diabetes is a risk factor for the morbidity and mortality of other viral infections, including 2009 influenza A (H1N1), MERS-CoV, and SARS-CoV [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the association between diabetes and COVID-19 prognosis is infrequently documented.\u003c/p\u003e \u003cp\u003eWe examined data from 365 COVID-19 patients in this retrospective cohort analysis, comprising 195 instances of diabetes and 170 cases of no diabetes. Our study's observations of elevated mortality risk in COVID-DM patients were consistent with results from earlier meta-analyses [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. There are a variety of ways in which DM could make COVID-19 patients more susceptible to death. This study demonstrates that the majority of people with diabetes mellitus (DM) in Syria have cardiometabolic comorbidities and chronic diabetic sequelae, which is partially attributable to the larger percentage of DM patients who receive a late diagnosis [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, despite the considerable reduction following the correction for severe cardiometabolic comorbidities, the link between DM and COVID-19 mortality remained significant, indicating alternative mechanisms may be involved. Aging cells, a stronger pro-inflammatory state, poorer T-cell activity, and decreased antibody production are only a few of the mechanisms that have been identified to be involved [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is significant to note that our study found that patients with DM were more likely to present with clinical symptoms than non-DM patients. We assessed the severity of each patient's illness in accordance with the criteria outlined in the methods, and we discovered that there were more critically ill patients in the diabetes group, which may indicate that diabetic patients are more likely to develop a severe condition after contracting SARS-CoV-2. These results are consistent with earlier research showing that DM raises the risk of developing a severe COVID-19 infection [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our results, however, differed from those of a prior study, which found that both the DM group and the non-DM group experienced identical COVID-19 pneumonia symptoms [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is crucial to note that additional factors, such as the limited experience during the early pandemic and the restricted availability of healthcare facilities, might also be a factor in the higher mortality [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These results can also indicate that there is still potential for improvement in Syrian's COVID-19 management.\u003c/p\u003e \u003cp\u003eOur study has a number of drawbacks. Firstly, this retrospective cohort study has a selection bias, and further prospective investigations are required. Second, to confirm our findings, more extensive multicenter research must be conducted as our research is solely based on a single-center study.\u003c/p\u003e"},{"header":"Conclusion:","content":"\u003cp\u003eIn conclusion, our analysis provided evidence that COVID-DM patients were more likely to experience clinical symptoms, in addition to confirming earlier reports that DM is independently related to a greater risk of COVID-19 death.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We are thankful to everyone who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this paper\u0026rsquo;s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board (IRB) at the Syrian Private University (SPU). All\u0026nbsp;Participants confirmed their written consent by signing the consent form.\u0026nbsp;Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHA and AA were responsible for study design, literature search, and write-up; HA was responsible for data analysis; AA participated in literature search and write-up; HB participated in the study design and reviewed the final draft. All authors read and approved the final draft.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Walls, A.C., et al., \u003cem\u003eStructure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein.\u003c/em\u003e Cell, 2020. \u003cstrong\u003e181\u003c/strong\u003e(2): p. 281-292.e6.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Zhou, J., et al., \u003cem\u003eMiddle East respiratory syndrome coronavirus infection: virus-host cell interactions and implications on pathogenesis.\u003c/em\u003e Virol J, 2015. \u003cstrong\u003e12\u003c/strong\u003e: p. 218.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Chan, J.F., et al., \u003cem\u003eMiddle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease.\u003c/em\u003e Clin Microbiol Rev, 2015. \u003cstrong\u003e28\u003c/strong\u003e(2): p. 465-522.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Muniyappa, R. and S. Gubbi, \u003cem\u003eCOVID-19 pandemic, coronaviruses, and diabetes mellitus.\u003c/em\u003e Am J Physiol Endocrinol Metab, 2020. \u003cstrong\u003e318\u003c/strong\u003e(5): p. 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We sought to comprehend how COVID-19's prognosis related to diabetes mellitus.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a retrospective, single-center cohort research conducted at Damascus Hospital from December 25, 2020 to March 20, 2021, 365 COVID-19 patients were enrolled. Data on demographics, clinical characteristics, laboratories, radiologic findings, therapies, complications, and clinical outcomes were taken from medical records and compared between groups with and without diabetes (n\u0026thinsp;=\u0026thinsp;195 and n\u0026thinsp;=\u0026thinsp;170).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 365 COVID-19 patients that were involved in the trial, 207 (57%) were men and 158 (43%) were women. Patients participating in COVID-19 were divided into two groups: those with diabetes (n\u0026thinsp;=\u0026thinsp;195) and those without the condition (n\u0026thinsp;=\u0026thinsp;170). Patients with diabetes had higher rates of symptoms such as fatigue (86.7%, P\u0026thinsp;=\u0026thinsp;0.000), dyspnea (93.8%, P\u0026thinsp;=\u0026thinsp;0.000), headache (32.8%, P\u0026thinsp;=\u0026thinsp;0.000), and chest discomfort (8.2%, P\u0026thinsp;=\u0026thinsp;0.000). We found that those with uncontrolled diabetes who were coronavirus-infected had a significant mortality rate, with a death rate of 64% in this group of patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prognosis of COVID-19 is independently at risk due to diabetes. Patients with diabetes, especially those who require insulin therapy, should get more focus on prevention and treatment.\u003c/p\u003e","manuscriptTitle":"The relationship between diabetes and the severity of COVID-19","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-16 21:01:51","doi":"10.21203/rs.3.rs-2062588/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09d279c3-4217-4d49-a9cc-549bc154101c","owner":[],"postedDate":"September 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":15505656,"name":"Pulmonology"},{"id":15505657,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2022-09-16T21:01:51+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-16 21:01:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2062588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2062588","identity":"rs-2062588","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}