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A Study on the Impact of Diabetes Mellitus on the Severity of COVID-19-Associated MucormycosisFunding None.
Objectives: Diabetes mellitus (DM) seems the most common predisposing factor for rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to study the impact of DM on the severity of COVID-19-associated ROCM (CAM).
Methods: This was a retrospective analytical study performed over a period of 3 months to assess the impact of DM on the severity of CAM in 100 patients and association of clinical correlates of DM with severity of CAM.
Statistical analysis: The data collected using the study tools were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised a descriptive analysis that involved calculating means, standard deviations, and proportions. For calculating the significance of the difference of mean between two groups, Student's t-test was applied. In addition, chi-square test (or Fisher's t-test if applicable) was applied to study the significance of association of clinical correlates of DM with severity of CAM for categorical variables and t-test for continuous variables.
Results: The prevalence of DM was 67%. The average presenting blood sugar level was 245.9 ± 99.86 mg%. Glycated hemoglobin level between 4.5 and 6.5% was observed in 57 patients and over 6.5% in 43 subjects. A high body mass index (BMI) of 25 and above was noted in 52 patients. A significantly higher level of presenting blood sugar and a longer duration of hospital stay was noted in patients having stage 3b or higher (p < 0.05) when compared with those having stage 3a or below. No significant correlation was observed in patients in stage 3a or below and those presenting with stage 3b or higher in terms of BMI, waist to hip ratio, or total cholesterol levels. There was a strong correlation between blood sugar level at presentation, severity of DM with the severity of ROCM, and a strong inverse correlation noted between HDL level and severity of ROCM.
Conclusion: A poor metabolic control is associated with a higher risk of a severe disease with intracranial involvement.
Article published online:
22 February 2023
© 2023. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi (Basel) 2021; 7 (04) 298 DOI: 10.3390/jof7040298.
- 2 Prakash H, Chakrabarti A. Epidemiology of mucormycosis in India. Microorganisms 2021; 9 (03) 523 . Published 2021 Mar 4. DOI: 10.3390/microorganisms9030523.
- 3 Patel A, Kaur H, Xess I. et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect 2020; 26 (07) 944.e9-944.e15 DOI: 10.1016/j.cmi.2019.11.021.
- 4 Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and pathophysiology of COVID-19-associated mucormycosis: India versus the rest of the world. Mycopathologia 2021; 186 (06) 739-754 DOI: 10.1007/s11046-021-00584-8.
- 5 Pal R, Singh B, Bhadada SK. et al. COVID-19-associated mucormycosis: an updated systematic review of literature. Mycoses 2021; 64 (12) 1452-1459 DOI: 10.1111/myc.13338.
- 6 Hoenigl M, Seidel D, Carvalho A. et al. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancer Microbe 2022; 3 (07) e543-e552
- 7 Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021; 15 (04) 102146 DOI: 10.1016/j.dsx.2021.05.019.
- 8 American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes - 2021. Diabetes Care 2021; 44 (Suppl. 01) S15-S33
- 9 Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010; 47 (03) 193-199 DOI: 10.1007/s00592-009-0109-4.
- 10 Roberts A, James J, Dhatariya K. Joint British Diabetes Societies (JBDS) for Inpatient Care. Management of hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group. Diabet Med 2018; 35 (08) 1011-1017 DOI: 10.1111/dme.13675.
- 11 Honavar SG. Code mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol 2021; 69 (06) 1361-1365 DOI: 10.4103/ijo.IJO_1165_21.
- 12 Misra A, Chowbey P, Makkar BM. et al; Concensus Group. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163-170
- 13 Singh AK, Gillies CL, Singh R. et al. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: a systematic review and meta-analysis. Diabetes Obes Metab 2020; 22 (10) 1915-1924 DOI: 10.1111/dom.14124.
- 14 Sathish T, de Mello GT, Cao Y. Is newly diagnosed diabetes a stronger risk factor than pre-existing diabetes for COVID-19 severity?. J Diabetes 2021; 13 (02) 177-178 DOI: 10.1111/1753-0407.13125.
- 15 Li B, Yang J, Zhao F. et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020; 109 (05) 531-538 DOI: 10.1007/s00392-020-01626-9.
- 16 Cariou B, Hadjadj S, Wargny M. et al; CORONADO investigators. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. [published correction appears in Diabetologia. 2020 Jul 2;] Diabetologia 2020; 63 (08) 1500-1515 DOI: 10.1007/s00125-020-05180-x.
- 17 Yang J, Zheng Y, Gou X. et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020; 94: 91-95 DOI: 10.1016/j.ijid.2020.03.017.
- 18 NHS England. Type 1 and Type 2 diabetes and COVID-19 related mortality in England. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30272-2/fulltext
- 19 Zhu L, She ZG, Cheng X. et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 2020; 31 (06) 1068-1077.e3 DOI: 10.1016/j.cmet.2020.04.021.
- 20 Wu J, Zhang J, Sun X. et al. Influence of diabetes mellitus on the severity and fatality of SARS-CoV-2 (COVID-19) infection. Diabetes Obes Metab 2020; 22 (10) 1907-1914 DOI: 10.1111/dom.14105.
- 21 Yancy CW. COVID-19 and African Americans. JAMA 2020; 323 (19) 1891-1892 DOI: 10.1001/jama.2020.6548.
- 22 Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med 2020; 8 (06) 547-548 DOI: 10.1016/S2213-2600(20)30228-9.
- 23 Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19?. BMJ 2020; 369: m1548 . Published 2020 Apr 20. DOI: 10.1136/bmj.m1548.
- 24 Sathish T, Tapp RJ, Cooper ME, Zimmet P. Potential metabolic and inflammatory pathways between COVID-19 and new-onset diabetes. Diabetes Metab 2021; 47 (02) 101204 DOI: 10.1016/j.diabet.2020.10.002.
- 25 Sathish T, Cao Y, Kapoor N. Newly diagnosed diabetes in COVID-19 patients. Prim Care Diabetes 2021; 15 (01) 194 DOI: 10.1016/j.pcd.2020.08.014.
- 26 Sathish T, Kapoor N, Cao Y, Tapp RJ, Zimmet P. Proportion of newly diagnosed diabetes in COVID-19 patients: A systematic review and meta-analysis. Diabetes Obes Metab 2021; 23 (03) 870-874 DOI: 10.1111/dom.14269.
- 27 American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2020 . Diabetes Care 2020; 43 (Suppl. 01) S14-S31 DOI: 10.2337/dc20-S002.
- 28 Wu L, Girgis CM, Cheung NW. COVID-19 and diabetes: Insulin requirements parallel illness severity in critically unwell patients. Clin Endocrinol (Oxf) 2020; 93 (04) 390-393 DOI: 10.1111/cen.14288.
- 29 WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: Meta-analysis A. JAMA 2020; 324 (13) 1330-1341 DOI: 10.1001/jama.2020.17023.
- 30 Horby P, Lim WS, Emberson JR. et al; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384 (08) 693-704 DOI: 10.1056/NEJMoa2021436.
- 31 Moorthy A, Gaikwad R, Krishna S. et al. SARS-CoV-2, uncontrolled diabetes and corticosteroids-an unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg 2021; 20 (03) 418-425 DOI: 10.1007/s12663-021-01532-1.
- 32 Müller JA, Groß R, Conzelmann C. et al. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab 2021; 3 (02) 149-165 DOI: 10.1038/s42255-021-00347-1.
- 33 Akarsu C, Karabulut M, Aydin H. et al. Association between acute pancreatitis and COVID-19: could pancreatitis be the missing piece of the puzzle about increased mortality rates?. J Invest Surg 2022; 35 (01) 119-125 DOI: 10.1080/08941939.2020.1833263.
- 34 Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 2021; 594 (7862): 259-264 DOI: 10.1038/s41586-021-03553-9.
- 35 Mekonnen ZK, Ashraf DC, Jankowski T. et al. Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome. Ophthal Plast Reconstr Surg 2021; 37 (02) e40-e80 DOI: 10.1097/IOP.0000000000001889.
- 36 Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Calleja-Alarcon S, Romero-Gutierrez L. A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus 2021; 13 (02) e13163 . Published 2021 Feb 5. DOI: 10.7759/cureus.13163.
- 37 Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a viral land: a tale of two pathogens. Indian J Ophthalmol 2021; 69 (02) 244-252 DOI: 10.4103/ijo.IJO_3774_20.
- 38 Gallo O, Locatello LG, Mazzoni A, Novelli L, Annunziato F. The central role of the nasal microenvironment in the transmission, modulation, and clinical progression of SARS-CoV-2 infection. Mucosal Immunol 2021; 14 (02) 305-316 DOI: 10.1038/s41385-020-00359-2.
- 39 Ahn JH, Kim J, Hong SP. et al. Nasal ciliated cells are primary targets for SARS-CoV-2 replication in the early stage of COVID-19. J Clin Invest 2021; 131 (13) e148517 DOI: 10.1172/JCI148517.
- 40 Alfishawy M, Elbendary A, Younes A. et al. Diabetes mellitus and coronavirus disease (Covid-19) associated mucormycosis (CAM): a wake-up call from Egypt. Diabetes Metab Syndr 2021; 15 (05) 102195 DOI: 10.1016/j.dsx.2021.102195.
- 41 Chen Z, John Wherry E. T cell responses in patients with COVID-19. Nat Rev Immunol 2020; 20 (09) 529-536 DOI: 10.1038/s41577-020-0402-6.
- 42 Hottz ED, Azevedo-Quintanilha IG, Palhinha L. et al. Platelet activation and platelet-monocyte aggregate formation trigger tissue factor expression in patients with severe COVID-19. Blood 2020; 136 (11) 1330-1341 DOI: 10.1182/blood.2020007252.
- 43 Feldman C, Anderson R. Brief review: cardiac complications and platelet activation in COVID-19 infection. Afr J Thorac Crit Care Med 2020; 26 (03) ): Published 2020 Sep 16. DOI: 10.7196/AJTCCM.2020.v26i3.107.
- 44 Choi GJ, Kim HM, Kang H. The potential role of dyslipidemia in COVID-19 severity: an umbrella review of systematic reviews. J Lipid Atheroscler 2020; 9 (03) 435-448 DOI: 10.12997/jla.2020.9.3.435.