diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13374diaendo-13501Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESСмертность у пациентов с сахарным диабетом 2 типа, перенесших коронавирусную инфекцию, в острой фазе заболевания и в отдаленном периодеMortality in patients with type 2 diabetes mellitus following coronavirus infection during the acute phase and long-term periodhttps://orcid.org/0009-0007-5028-7678СаркисянД. Р.SarkisianD. R.

Саркисян Диана Рубеновна

129110, Москва, ул. Щепкина, д. 61/2

Diana R. Sarkisian - MD.

61/2 Shchepkina street, 129110 Moscow

dr.sarkisyan-33@yandex.ruhttps://orcid.org/0000-0001-7327-2486КовалеваЮ. А.KovalevaJ. A.

Ковалева Юлия Александровна - к.м.н., с.н.с.

Москва

Julia. A. Kovaleva - PhD, senior research associate.

Moscow

yulia.kovaleva@mail.ruhttps://orcid.org/0000-0001-6122-0638ГлазковА. А.GlazkovA. A.

Глазков Алексей Андреевич, к.м.н.; ScopusAuthorID: 57199329515; WoS ResearcherID: R-7373-2016.

Москва

Alexey A. Glazkov - MD, PhD.; ScopusAuthorID: 57199329515; WoS ResearcherID: R-7373-2016.

Moscow

aaglazkov@bk.ruhttps://orcid.org/0000-0001-6033-5564КакоринаЕ. П.KakorinaE. P.

Какорина Екатерина Петровна - д.м.н.; ScopusAuthor ID: 6603596338; WoS Researcher ID: Y-2277-2019; eLibrary SPIN: 2909-9069.

Москва

Ekaterina P. Kakorina - MD, PhD; ScopusAuthor ID: 6603596338; WoS Researcher ID: Y-2277-2019; eLibrary SPIN: 2909-9069.

Moscow

kakorina@list.ruhttps://orcid.org/0000-0003-1668-8711МисниковаИ. В.MisnikovaI. V.

Мисникова Инна Владимировна - д.м.н.; ScopusAuthor ID: 559756.

Москва

Inna V. Misnikova - MD, PhD; ScopusAuthor ID: 559756.

Moscow

inna-misnikova@mail.ruМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияMoscow Regional Research Clinical Institute named after M.F. VladimirskyRussian FederationМосковский областной научно-исследовательский клинический институт им. М.Ф. Владимирского; Сеченовский УниверситетРоссияMoscow Regional Research Clinical Institute named after M.F. Vladimirsky; Sechenov UniversityRussian Federation202618052026292137147Copyright © Саркисян Д.Р., Ковалева Ю.А., Глазков А.А., Какорина Е.П., Мисникова И.В., 20262026Саркисян Д.Р., Ковалева Ю.А., Глазков А.А., Какорина Е.П., Мисникова И.В.Sarkisian D.R., Kovaleva J.A., Glazkov A.A., Kakorina E.P., Misnikova I.V.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/13501ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Сахарный диабет 2 типа (СД2) является одним из главных факторов риска тяжелого течения и повышенного риска смерти при COVID-19. Долгосрочные последствия перенесенной инфекции остаются неясными.

ЦЕЛЬ

ЦЕЛЬ. Оценить летальность и факторы риска смерти у пациентов с СД2 после перенесенного COVID-19 как в остром, так и отдаленном периодах.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Обсервационное ретроспективное исследование по типу «случай-контроль». В исследование включались пациенты с СД2 старше 18 лет, у которых было указание о перенесенном COVID-19 в Базе данных клинико-эпидемиологического мониторинга СД на территории Российской Федерации за период с 2020 по 2022 гг. В контрольную группу вошли все пациенты с СД2 без COVID-19 в анамнезе, независимо от исхода. Далее в контрольной группе оценивалась летальность в период с 2020 г. по 2022 г. по причинам, не связанным с COVID-19. Статистический анализ проводили в программе RStudio 2024.04.02 (Posit Software, PBC) с помощью языка программирования R версии 4.3.3.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. В исследование включено 7625 пациентов с СД2, перенесших COVID-19, и 212 352 пациента с СД2, у которых в анамнезе отсутствовали данные о перенесенном COVID-19. Летальность с 2020 по 2022 гг. в группе пациентов, перенесших COVID-19, составила 24,6%, из которой летальность в остром периоде составила 21,7%. Это было выше, чем в группе контроля — 14,1% (р<0,001). В отдаленном периоде после перенесенного COVID-19 факторами, повышающими риск смерти, были: старший возраст — ОШ 1,06; 95% ДИ 1,04; 1,07, р<0,001, большая длительность СД2 — ОШ 1,03; 95% ДИ 1,01;1,05, р<0,05, дебют заболевания в более старшем возрасте — ОШ 1,04; 95% ДИ 1,02;1,05, р<0,001. Более низкий риск смерти в отдаленном периоде ассоциирован с приемом ингибиторов натрий-глюкозного котранспортера 2 типа (иНГЛТ-2) — HR 0,45; 95% ДИ 0,29; 0,70, p<0,001 и метформина — HR 0,40; 95% ДИ 0,30; 0,54, p<0,001.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Летальность была выше в группе пациентов, перенесших COVID-19, в сравнении с контрольной группой. Увеличение летальности связано со смертью в остром периоде. Факторами, ассоциированными с повышением вероятности смерти у больных с СД2, перенесших COVID-19, в отдаленном периоде, после построения скорректированных на пол и возраст моделей были: более старший возраст, мужской пол, применение инсулина, а протекторными факторами — прием иНГЛТ-2 и метформина.

BACKGROUND

BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the major risk factors for severe COVID-19 and increased mortality. The long-term consequences of the infection remain unclear.

AIM

AIM: To assess mortality and risk factors for death in patients with T2DM after COVID-19, both in acute phase and long-term follow-up.

MATERIALS AND METHODS

MATERIALS AND METHODS: This was a retrospective observational case-control study. Study included patients over 18 years of age with T2DM and recorded history of COVID-19 in clinical-epidemiological diabetes monitoring database from 2020 to 2022. Control group consisted of patients with T2DM who died between 2020 and 2022 from causes not related to COVID-19. Statistical analysis performed using RStudio 2024.04.02 (Posit Software, PBC) with R programming language, version 4.3.3.

RESULTS

RESULTS: The study included 7,625 patients with T2DM who had recovered from COVID-19 and 212,352 patients with T2DM without a documented history of COVID-19. From 2020 to 2022, the mortality rate in the post-COVID group was 24.6%, of which 21.7% occurred during the acute phase. This was significantly higher than in the control group (14.1%, p<0.001).

In the long-term period after COVID-19, the following factors were associated with increased mortality risk: older age (OR 1.06; 95% CI 1.04–1.07, p<0.001), longer diabetes duration (OR 1.03; 95% CI 1.01–1.05, p<0.05), and older age at diabetes onset (OR 1.04; 95% CI 1.02–1.05, p<0.001).

A lower risk of death in the long-term period was associated with the use of SGLT2 inhibitors (HR 0.45; 95% CI 0.29–0.70, p<0.001) and metformin (HR 0.40; 95% CI 0.30–0.54, p<0.001).

CONCLUSION

CONCLUSION: Mortality was higher among patients with history of COVID-19 compared to control group. Increase in mortality was primarily due to deaths in acute phase of infection. After adjusting for sex, age, following factors were independently associated with increased long-term mortality in T2DM patients after COVID-19: older age, male sex, insulin therapy. Protective factors included use of SGLT2 inhibitors and metformin.

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