Analysis of adverse outcomes of the endocrine system diseases, prediction of the risk of fatal outcome in patients with type 2 diabetes mellitus and COVID-19

• Tatyana P. Demicheva

Abstract

The purpose of this study: to analyze adverse outcomes in patients with type 2 diabetes mellitus (T2DM), their causes and prognosis, to establish risk factors for mortality in patients with T2DM and new coronavirus infection 2019 (COVID‑19).

Material and methods. The study used data from the official statistics of the regional medical information and analytical center for a 15-year period, the register of patients with diabetes. The analysis of the case histories of patients who had a new coronavirus infection (NCVI) and who died from NCVI was carried out. Using a multivariate logistic regression analysis, an assessment of risk factors in the development of a fatal outcome from a new coronavirus infection in patients with T2DM was given. Intensive, extensive and prognostic standardized indicators were calculated. The statistical significance of the identified trends was judged by the degree of approximation with a 95% confidence interval.

Results. In 2019 the mortality rate of the population of the Perm region due to diseases of the endocrine system reached 41.2, from diabetes – ​40.3 per 100 000 of the population. Over the 15-year pre-COVID period, the indicator increased by 3.8 times compared to 2003. In 2021, the death registration rate reached 45.0 per 100 000 population. The proportion of diabetes mellitus (DM) in the structure of causes of death due to diseases of the endocrine system is 97.8%. According to the registry of DM in the Perm region, the main direct causes of death in patients with T2DM are cardiovascular (57.9%), cancer (11.15%), DM (11.76%). Considering the importance of predicting the risk of death in patients with T2DM in combination with a new coronavirus infection, an express method was developed based on the use of statistically significant diagnostic criteria. Identified risk factors (blood oxygen level below 90.12%, lung damage area over 45.8%, fasting glycemia above 7 mmol/l) of fatal outcomes in patients with T2DM with COVID‑19 allow appropriate individual treatment to be carried out in a timely manner and to optimize the treatment regimen.

Conclusion. An idea about the size, trends, and characteristics of adverse outcomes of T2DM in the Perm region was obtained. The increase in morbidity and mortality from T2DM observed in the region requires an active impact on risk factors. The identified statistically significant risk factors for the occurrence of fatal outcomes in patients with T2DM with COVID 19 allow the doctor to predict the risk of lethality at any time during contact with the patient. The calculation results can be used to optimize management decisions in a pandemic and to preserve the individual health of citizens.

Keywords:adverse outcomes; diseases of the endocrine system; mortality risk prediction; type 2 diabetes mellitus; new coronavirus infection

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