Determinants of mortality among COVID-19 patients with diabetes mellitus in Addis Ababa, Ethiopia, 2022: An unmatched case-control study
Authors: Mekonnen Migbar Sibhat , Tsegaw Melsew Getnet , Zewde Wuletaw Chane , Tiruneh Kassie Gebeyehu , Sane Asaminew Habtamu , Ashine Taye Mezgebu , Beyene Hailu Asmare , Mengistie Melkie Ambaw , Mesfin Edmialem Getahun 
Published: April 2022

Introduction

COVID-19 remains one of the leading causes of death seeking global public health attention. Diabetes mellitus is associated with severity and lethal outcomes up to death independent of other comorbidities. Nevertheless, information regarding the determinant factors that contributed to the increased mortality among diabetic COVID-19 patients is limited. Thus, this study aimed at identifying the determinants of mortality among COVID-19 infected diabetic patients.

Methods

An unmatched case-control study was conducted on 340 randomly selected patients by reviewing patient records. Data were collected using a structured extraction checklist, entered into Epi data V-4.4.2.2, and analyzed using SPSS V-25. Then, binary logistic regression was used for bivariate and multivariable analysis. Finally, an adjusted odds ratio with 95% CI and a p-value of less than 0.05 was used to determine the strength of association and the presence of a statistical significance consecutively.

Results

The study was conducted on 340 COVID-19 patients (114 case and 226 controls). Patient age (AOR=4.90; 95% CI: 2.13, 11.50), severity of COVID-19 disease (AOR=4.95; 95% CI: 2.20, 11.30), obesity (AOR=7.78; 95% CI: 4.05, 14.90), hypertension (AOR=5.01; 95% CI: 2.40, 10.60), anemia at presentation (AOR=2.93; 95% CI: 1.29, 6.65), and AKI after hospital admission (AOR=2.80; 95% CI: 1.39, 5.64) had statistically significant association with increased mortality of diabetic patients with COVID-19 infection. Conversely, presence of RVI co-infection was found to be protective against mortality (AOR=0.35; 95% CI: 0.13, 0.90).

Conclusion

Patient age (<65years), COVID-19 disease severity (mild and moderate illness), presence of hypertension, obesity, anemia at admission, and AKI on admission was independently associated with increased mortality of diabetic COVID-19 patients. Contrariwise, the presence of RVI co-infection was found to be protective against patient death. Consequently, COVID-19 patients with diabetes demand untiring efforts, and focused management of the identified factors will substantially worth the survival of diabetic patients infected with COVID-19.

What is already known on this topic?

Diabetes mellitus is associated with severity and lethal outcomes up to death independent of other comorbidities. Previous studies indicated that diabetic patients have almost four times increased risk of severe disease and death due to COVID-19 infection. Consequently, with this increased mortality and other public health impacts, numerous reports have been evolved worldwide on the link between COVID-19 and DM, and diabetes management during the COVID-19 pandemic. However, information regarding the determinant factors that lead to the increased mortality among diabetic COVID-19 patients is not well-studied yet.

What this study adds?

Patient age (<65years), COVID-19 disease severity (mild and moderate illness), presence of hypertension, obesity, anemia at admission, and AKI on hospital admission were independently associated with increased mortality of COVID-19 patients with DM.

In addition, RVI co-infection was found to be protective against patient death.