diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12954diaendo-12954Research ArticleОригинальные исследованияOriginal StudiesАнализ рисков летальности 337 991 пациента с сахарным диабетом, перенесшего COVID-19, за период 2020–2022 гг.: всероссийское ретроспективное исследованиеAnalysis of risk factors for COVID-19-related fatal outcome in 337991 patients with type 1 and type 2 diabetes mellitus in 2020–2022 years: Russian nationwide retrospective studyhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна - доктор медицинских наук, профессор, член-корр. РАН. SPIN: 5624-3875

Москва

Natalya G. Mokrysheva, MD, PhD, Professor; eLibrary SPIN: 5624-3875.

Moscow

nm70@mail.ruhttps://orcid.org/0000-0002-5057-127XШестаковаМ. В.ShestakovaM. V.

Шестакова Марина Владимировна - доктор медицинских наук, профессор, академик РАН]; eLibrary SPIN: 7584-7015.

Москва

Marina V. Shestakova - MD, PhD, Professor; eLibrary SPIN: 7584-7015.

Moscow

nephro@endocrincentr.ruhttps://orcid.org/0000-0003-0571-8882ВикуловаО. К.VikulovaO. K.

Викулова Ольга Константиновна - доктор медицинских наук, доцент; eLibrary SPIN: 9790-2665.

117036, Москва, ул. Дм. Ульянова, д. 11

Olga K. Vikulova - MD, PhD, associate professor; eLibrary SPIN: 9790-2665.

11 Dm. Ulyanova street, 117036 Moscow

olga-vikulova-1973@yandex.ruhttps://orcid.org/0000-0001-6935-3187ЕлфимоваА. Р.ElfimovaA. R.

Елфимова Алина Ринатовна - eLibrary SPIN: 9617-7460

Москва

Alina R. Elfimova- eLibrary SPIN: 9617-7460

Moscow

9803005@mail.ruhttps://orcid.org/0000-0001-9760-1117ИсаковМ. А.IsakovM. A.

Исаков Михаил Андреевич - кандидат биологических наук, eLibrary SPIN: 5870-8933

Москва

Mikhail А. Isakov - PhD in Biology, eLibrary SPIN: 5870-8933

Moscow

m.isakov@aston-health.comГинсН. А.GinsN. A.

Гинс Николай Александрович

Москва

Nikolai A. Gins

Moscow

gins_nik@mail.ruhttps://orcid.org/0000-0003-0789-4601ДевяткинА. А.DeviatkinA. A.

Девяткин Андрей Андреевич - кандидат биологических наук; eLibrary SPIN: 3058-2176.

Москва

Andrei A. Deviatkin - PhD in Biology; eLibrary SPIN: 3058-2176.

Moscow

andreideviatkin@gmail.comhttps://orcid.org/0000-0002-8175-7886ДедовИ. И.DedovI. I.

Дедов Иван Иванович - доктор медицинских наук, профессор, академик РАН; Researcher ID: D-3729-2014; Scopus Author ID: 7101843976; eLibrary SPIN: 5873-2280.

Москва

Ivan I. Dedov - MD, PhD, Professor; Researcher ID: D-3729-2014; Scopus Author ID: 7101843976; eLibrary SPIN: 5873-2280.

Moscow

dedov@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202230112022255404417Copyright © Мокрышева Н.Г., Шестакова М.В., Викулова О.К., Елфимова А.Р., Исаков М.А., Гинс Н.А., Девяткин А.А., Дедов И.И., 20222022Мокрышева Н.Г., Шестакова М.В., Викулова О.К., Елфимова А.Р., Исаков М.А., Гинс Н.А., Девяткин А.А., Дедов И.И.Mokrysheva N.G., Shestakova M.V., Vikulova O.K., Elfimova A.R., Isakov M.A., Gins N.A., Deviatkin A.A., Dedov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12954Актуальность

Актуальность. Пандемия коронавирусной инфекции внесла крайне негативный вклад в аспекты ведения пациентов с сахарным диабетом (СД), ставших «мишенью» вируса как в плане более тяжелого течения COVID-19, так и повышения риска смертности.

Цель

Цель. Провести анализ факторов риска развития летального исхода вследствие COVID-19 у пациентов с СД 1 и 2 ­типов (СД1 и СД2).

Материалы и методы

Материалы и методы. Ретроспективный анализ базы данных Федерального регистра СД (ФРСД), включивший 15 712 пациентов с СД1 и 322 279 пациентов с СД2 с перенесенным COVID-19 и указанным исходом заболевания (­выздоровление/смерть) за 2 года наблюдения (с 01.02.2020 по 03.04.2022 (дата выгрузки)).

Результаты

Результаты. Летальность пациентов с СД, перенесших COVID-19, составила 17,1% (СД1 — 8,8%; СД2 — 17,5%). В результате регрессионного многофакторного анализа из 7 значимых факторов при СД1 и 13 при СД2 установлены совокупности наиболее значимых предикторов риска летального исхода. При СД1 такими факторами были: возраст ≥65 лет (отношение шансов (ОШ)=4,01; 95% доверительный интервал (ДИ) 1,42–11,36), наличие артериальной гипертензии (АГ) (ОШ=2,72; 95% ДИ 1,03–7,16) и синдрома диабетической стопы (СДС) (ОШ=7,22; 95% ДИ 1,98–26,29); при СД2: возраст ≥65 лет (ОШ=2,53; 95% ДИ 1,96–3,27), мужской пол (ОШ=1,51; 95% ДИ 1,23–1,84), длительность СД≥10 лет (ОШ=2,01; 95% ДИ 1,61–2,51), индекс массы тела (ИМТ) ≥30 кг/м2 (ОШ=1,26; 95% ДИ 1,02–1,55), наличие атеросклеротических сосудистых заболеваний (АССЗ)/хронической болезни почек (ХБП) (ОШ=1,49; 95% ДИ 1,01–2,04), диабетической комы в анамнезе (ОШ=12,97; 95% ДИ 1,89–88,99) и инвалидности (ОШ=1,40; 95% ДИ 1,14–1,73). При СД2 значимое влияние оказывал вид антидиабетической терапии (АДТ) до COVID-19 (последний визит до развития инфекции): инсулинотерапия (ОШ=1,64; 95% ДИ 1,30–2,07), сульфонилмочевина (СМ) (ОШ=1,51; 95% ДИ 1,23–1,84); терапия ингибиторами дипептидилпептидазы-4 (иДПП-4) (ОШ=0,57; 95% ДИ 0,39–0,83) и ингибиторами натрий-глюкозного котранспортера 2 типа (иНГЛТ2) (ОШ=0,64; 95% ДИ 0,46–0,88). Вакцинация при обоих типах СД была наиболее значимым протективным фактором: СД1 — ОШ=0,19; 95% ДИ 0,06–0,59; СД2 — ОШ=0,20; 95% ДИ 0,16–0,26.

Заключение

Заключение. Общим фактором риска летального исхода при СД1 и СД2 был возраст ≥65 лет; при СД1 — наличие АГ и СДС в анамнезе, при СД2 — мужской пол, длительность СД≥10 лет, ИМТ≥30 кг/м2, наличие в анамнезе АССЗ/ХБП и диабетической комы, инвалидность. Выраженные различия в рисках летального исхода отмечались при СД2 в зависимости от характера АДТ: терапия инсулином и СМ являлись факторами, повышающими риск летальности, а терапия иДПП-4 и иНГЛТ2, напротив, снижала риски летального исхода. Вакцинация снижала риск летальности в 5,2 и 5 раз при СД1 и СД2 соответственно.

BACKGROUND

BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death.

AIM

AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2).

MATERIALS AND METHODS

MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)).

RESULTS

RESULTS: Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1–8.8%; DM2–17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age ≥65 years (OR =4.01, 95% CI: 1.42–11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98–26.29); for T2DM: age ≥ 65 years (OR =2.53, 95% CI: 1.96–3.27), male (OR =1.51, 95% CI: 1.23–1.84), duration DM ≥10 years (OR =2.01, 95% CI: 1.61–2.51), BMI ≥ 30 kg/m2 (OR =1.26, 95% CI: 1.02–1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01–2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89–88.99) and presence of disability ( OR =1.40, 95% CI: 1.14–1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30–2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23–1.84)); dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39–0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46–0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06–0.59; SD2 OR =0.20, 95% CI: 0.16–0.26.

CONCLUSION

CONCLUSION: The common risk factor for fatal outcome in both DM1 and DM2 was age ≥65 years; in DM1 — history of hypertension and DFS, in DM2 — male sex, diabetes duration ≥10 years, BMI ≥30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.

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The authors declare that there are no conflicts of interest present.