Clinical outcome of patients with diabetes mellitus infected by SARS-COV-2

Introduction: Diabetes, a chronic metabolic disease with high prevalence in Brazil, is a risk factor for severe SARS COV-2 infection. The relationship between previous glycemic control and the prognosis of patients hospitalized with COVID-19 is not fully understood. Objective : analyze the clinical outcome of patients with diabetes mellitus infected by SARS-COV-2. Outlining : A retrospective analysis of medical records was carried out using the Trakcare electronic system of all diabetic patients hospitalized with a confirmatory diagnosis of pneumonia due to COVID-19 in the medical clinic ward of HRAN, from June to August 2021, who, upon admission, performed the glycated hemoglobin test and analyzed it using the SPSS software (20.0). Results : A sample of 52 patients was obtained during the study period. Most patients are female, with a mean age of approximately 58 years. The comorbidity most associated with the participants was systemic arterial hypertension, with most diabetics presenting good prior glycemic control, represented by HbA1c ≤ 7%. The lethality found was 7.7%. Implications : The study shows a high lethality of diabetic patients infected by COVID-19, but no statistical significance was found for HbA1c levels with the increase in length of stay, use of non-rebreathing mask, need for invasive mechanical ventilation or lethality


INTRODUCTION
The COVID-19 disease, caused by the pathogen SARS-CoV-2, has considerably affected several sectors, including healthcare. It has become one of the biggest public health problems in the 21st century, of ongoing international importance. 1 There are risk groups that, given the high vulnerability of this disease, require specialized care. 2 Among

METHOD
This is an analytical, cross-sectional, retrospective study with a quantitative approach, which followed the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). 11 The study site was a (n=20) of them values three times higher than the laboratory reference (Table 1).   In the context of inflammatory evidence, most patients with lymphopenia 30.8% (n=4), altered LDH, 34.9% (n=15), and ferritin 35% (n=7) were found in group 1 (HB1Ac: ≤7%). In opposition, 66.7% (n=2) of patients who had 50 to 75% lung involvement evidenced by chest CT were in group 4 (HB1Ac: > 10%), and the only one with involvement greater than 75% was found in group 2 (HB1Ac: > 7 to ≤ 9%) ( Table   2).    (Table 3).    during the evolution of the pandemic. The orientation the Ministry of Health exposed at the beginning of the pandemic was to proceed with orotracheal intubation in patients using supplemental oxygen therapy with a flow higher than 5l/min. This management was  16 In this study, the instruction to delay orotracheal intubation was reproduced, 48.1% of participants required the use of NRM, but only 13.5% progressed to IMV. Spontaneous respiratory effort due to hypoxia causes increased inspiration culminating in increased negative pressure generated within the thorax. This manifestation perpetuates inflammation and may cause alveolar edema and pulmonary fibrosis, worsening the prognosis of these patients.

DISCUSSION
The orientation to delay the start of mechanical ventilation may be associated with increased mortality. 7,8 The national and worldwide lethality of the disease in the general population is around 2.8%, but the study showed a higher lethality of 7.7%. 9 In this context, patients with diabetes showed a higher lethality rate than general patients infected with

CONCLUSION
The study shows a high lethality of diabetic patients infected with COVID-19 but did not find statistical significance of HbA1c levels with increased length of stay, use of non-rebreathing mask, need for ventilation, and invasive mechanics.
However, the high lethality of 7.7% found in diabetic patients with SARS-CoV-2, seen at the study site, represents almost three times the overall national lethality, this raises concern for this risk group.
Knowledge of the variables influencing the outcome of these patients can guide health services in the creation of protocols that can improve the care and management of these patients, to reduce the number of deaths and their complications.