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Research ArticleOriginal Article
Open Access

Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates

Noha M. Elemam, Haifa Hannawi, Issa Al Salmi, Kashif Bin Naeem, Fahdah Alokaily and Suad Hannawi
Saudi Medical Journal February 2021, 42 (2) 170-180; DOI: https://doi.org/10.15537/smj.2021.2.25700
Noha M. Elemam
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
B.Pharma, PhD
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Haifa Hannawi
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
BDS, PhD
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Issa Al Salmi
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
MBBS, PhD
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Kashif Bin Naeem
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
MBBS,MRCP
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Fahdah Alokaily
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
MBBS, PhD
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Suad Hannawi
From the Sharjah Institute for Medical Research, College of Medicine (Elemam), University of Sharjah, Sharjah; from the Ministry of Health and Prevention, Department of Medicine (Hannawi H, Bin Naeem, Hannawi S); from Mohammed bin Rashid University of Medicine and Health Sciences (Hannawi H), Dubai, United Arab Emirates; from Oman Medical Specialty Board (Issa Al Salmi); from The Royal Hospital (Issa Al Salmi), Muscat, Oman; and from Prince Sultan Military Medical City (Alokaily), Riyadh, Kingdom of Saudi Arabia.
FRPC, PhD
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  • For correspondence: [email protected]
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  • Figure 1.
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    Figure 1.

    - Gender, age, and risk factors associated with COVID-19 infection. Bar graph showing A) the number of male and female of COVID-19 positive patients, B) the percentage of male subjects in the diabetic and non-diabetic COVID-19 patients. C) Age, D) travel history, E) contact history were compared between diabetic and non-diabetic COVID-19 patients. F) percentage of patients with hypertension. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001

  • Figure 2.
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    Figure 2.

    - Clinical symptoms and blood laboratory tests of COVID-19 subjects. Percentage of COVID-19 patients with A) fever, B) shortness of breath (SOB), C) rhinorrhea in diabetic and non-diabetic groups. D) Lymphocyte count, E) percent of patients with lymphopenia, F) neutrophil count, G) percent of patients with neutrophilia, H) white cell count (WCC), I) hemoglobin, J) percent of patients with high ferritin were compared between diabetic and non-diabetic COVID-19 patients. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001

  • Figure 3.
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    Figure 3.

    - Renal and liver function blood tests in COVID-19 subjects. A) sodium: Na levels, B) potassium: K levels, C) urea D) creatinine E) eGFR, and F) albumin were compared in the diabetic and non-diabetic groups. * p<0.05, ** p<0.01, *** p<0.001, ****p<0.0001

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    Figure 4.

    - Radiological assessment and clinical outcomes of diabetic COVID-19 patients. The percentage of patients with A) chest x-ray showing bilateral consolidation and B) CT scan showing bilateral peripheral ground-glass opacities was compared in diabetic and non-diabetic COVID-19 patients. The percentage of COVID-19 patients with C) mild/moderate and D) critical clinical outcome as well as the percentage of E) those admitted to ICU and F) death in COVID-19 were compared in diabetic and non-diabetic groups *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001

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    Figure 5.

    - Disease severity and coagulation markers in COVID-19 patients. A) CRP, C) procalcitonin, F) D-dimer, and H) INR levels in diabetic and non-diabetic COVID-19 patients. The percentage of patients with B) high CRP, D) high procalcitonin, E) high LDH, and G) high D-dimer in diabetic compared to non-diabetic COVID-19 patients. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001

Tables

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    Table 1.

    - Demographic data and comorbidities of the diabetic and non-diabetic COVID-19 patients included in the study.

    VariablesNon-diabetic COVID-19 (n=239)Diabetic COVID-19 (n=111)P-value
    Demographic data
     Gender (M/F)181/5893/180.045
     Age at diagnosis44.64 ± 14.3853.73 ± 12.79<0.0001
     Travel history (yes/no)26/2122/1090.002
     Contact history (yes/no)69/17021/890.026
    Risk factors and comorbidities
     Old age (yes/no)44/19540/710.0002
     CVD (yes/no)7/2326/1050.127
     HTN (yes/no)43/19658/52<0.0001
     Prior stroke (yes/no)2/2371/1100.476
     Cancer (yes/no)2/2370/1110.167
     Chronic lung disease (yes/no)9/2302/1090.164
     CKD (yes/no)5/2341/1100.212
    • CKD: chronic kidney disease, CVD: cardiovascular disease, HTN: hypertension

    • View popup
    Table 2.

    - Clinical symptoms, disease severity markers, and radiographic data of the diabetic and non-diabetic COVID-19 patients included in the study.

    Symptoms/disease severity markersNon-diabetic COVID-19 patients (n=239)Diabetic COVID-19 patients (n=111)P-value
    Symptoms
     Fever (yes/no)139/10078/330.015
     Cough (yes/no)131/10864/470.309
     Fatigue (yes/no)15/2246/1050.375
     Anorexia (yes/no)6/2233/1080.458
     Shortness of breath (yes/no)90/14953/580.037
     Sputum production (yes/no)3/2360/1110.118
     Myalgias (yes/no)23/21614/970.199
     Headache (yes/no)20/2194/1070.0504
     Rhinorrhea (yes/no)16/2231/1100.0095
     Sore throat (yes/no)24/21510/1010.381
     Vomiting (yes/no)6/2333/1080.458
     Diarrhea (yes/no)11/2276/1050.376
     Nausea (yes/no)6/2332/1090.34
     Anosmia (yes/no)1/2381/1100.289
     Ageusia (yes/no)1/2380/1110.248
    Disease severity markers
     CRP62.45 ± 79.6597.23 ± 96.39<0.0001
     High CRP (>3) (yes/no)185/52101/100.002
     D-dimers2.449 ± 5.0624.612 ± 9.0930.042
     High D-dimers (>0.5) (yes/no)118/12172/390.004
     LDH398.8 ± 353.2409.8 ± 264.10.197
     High LDH (>227) (yes/no)144/8987/230.0007
     Procalcitonin0.4242 ± 1.4741.587 ± 5.974<0.0001
     High procalcitonin (>0.1) (yes/no)79/15959/510.0001
     Ferritin1028 ± 12771207 ± 19380.188
     High ferritin (>388) (yes/no)111/12874/370.0002
    Radiographic data
     Chest x-ray: bilateral airspace consolidation (yes/no)120/10472/310.003
     CT chest: bilateral peripheral ground glass opacities (yes/no)152/6676/150.0060
    • CRP: C-reactive protein, LDH: lactate dehydrogenase

    • View popup
    Table 3.

    - Blood, renal, and liver tests of the diabetic and non-diabetic COVID-19 patients included in the study.

    TestsNon-diabetic COVID-19 patients (n=239)Diabetic COVID-19 patients (n=111)P-value
    Blood tests
     Neutrophil count5.971 ± 3.8087.395 ± 4.5670.002
     Neutrophilia (>14) (yes/no)17/22221/900.0005
     Lymphocyte count2.255 ± 11.831.256 ± 0.66930.006
     Lymphopenia (<1) (yes/no)65/17447/640.003
     Hb13.43 ± 1.83912.63 ± 2.1100.002
     WCC8.225 ± 4.06410.65 ± 15.360.015
     Platelets255.4 ± 103.5257.5 ± 92.970.421
     INR1.07 ± 0.15231.349 ± 2.5660.04
     Prothrombin time12.76 ± 6.62212.45 ± 1.6290.582
    Renal and liver tests
     Na137.1 ± 4.122136.4 ± 5.6870.03
     K3.963 ± 0.54844.191 ± 0.71820.005
     Urea5.632 ± 5.3768.722 ± 9.491< 0.0001
     Creatinine92.12 ± 65.74139.6 ± 231.70.015
     eGFR94.1 ± 29.8176.35 ± 34.28< 0.0001
     Bilirubin15.62 ± 33.4713.31 ± 9.1240.77
     ALT76.01 ± 163.655.05 ± 40.90.545
     AST60.34 ± 156.648.98 ± 36.690.369
     High ALT/AST (>63/37) (yes/no)114/12560/510.134
     ALP85.87 ± 51.1990.28 ± 39.680.11
     Albumin31.58 ± 7.58827.79 ± 7.43< 0.0001
    • ALP: alkaline phosphatase, ALT: alanine aminotransferase, AST: aspartate aminotransferase, eGFR: estimated glomerular filtration rate, Hb: hemoglobin, INR: international normalized ratio, K: potassium ions, Na: sodium ions, WCC: white cell count

    • View popup
    Table 4.

    - Illness severities and clinical outcomes of the diabetic and non-diabetic COVID-19 patients.

    Severities/outcomesNon-diabetic COVID-19 patients (n=239)Diabetic COVID-19 patients (n=111)P-value
    Illness severity
     Mild to moderate (yes/no)110/12928/830.0001
     Severe (yes/no)85/15439/720.469
     Critical (yes/no)44/194*44/67<0.0001
    Clinical outcome
     Duration of illness (days)5.714 ± 3.1435.928 ± 3.150.549
     Admission to intensive care unit (yes/no)46/19348/63<0.0001
     Death (yes/no)24/21540/71<0.0001
    • ↵* one case was missing this information

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Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates
Noha M. Elemam, Haifa Hannawi, Issa Al Salmi, Kashif Bin Naeem, Fahdah Alokaily, Suad Hannawi
Saudi Medical Journal Feb 2021, 42 (2) 170-180; DOI: 10.15537/smj.2021.2.25700

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Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates
Noha M. Elemam, Haifa Hannawi, Issa Al Salmi, Kashif Bin Naeem, Fahdah Alokaily, Suad Hannawi
Saudi Medical Journal Feb 2021, 42 (2) 170-180; DOI: 10.15537/smj.2021.2.25700
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