Structure of mortality among patients with diabetes mellitus in the republic of Uzbekistan during COVID-19 pandemia

BACKGROUND. The COVID-19 pandemic has caused enormous damage to all countries of the world. Patients with diabetes mellitus are a separate risk group for the consequences of COVID-19, both in the acute and in the long-term period.

AIM. To study change in the structure of mortality among patients with diabetes in the Republic of Uzbekistan during the COVID-19 pandemic.

MATERIALS AND METHODS. We analyzed the data of the report forms of endocrinological dispensaries for reasons of deaths registered among patients with 2 diabetes mellitus in 2020 and compared these indicators with the data of 2019.

RESULTS. In 2020, mortality among patients with diabetes increased 1.5 times compared to 2019 and was 4.3% (compared to 2.8% in 2019). Among the causes of deaths, cardiovascular accidents prevailed: 57,9% in 2020 (48,0% in 2019), cerebrovascular accidents (15,6% in 2020 and 24,2% in 2019), chronic kidney disease (12,0% and 15,1%), gangrene, sepsis (1,2% and 1,8%), the frequency of hyper- and hypoglycemic comas as causes of death was 0.6% both in 2019 and in 2020, however, the absolute number increased in 2020. Among the «other» causes of death (12.8% in 2020 and 10,2% in 2019), COVID-19 itself was 52,3%, pneumonia 17,2%, pulmonary embolism 1%, oncological diseases 12%, liver cirrhosis 12%.

CONCLUSIONS. Despite the fact that COVID-19 caused deaths in 6.7% of patients with diabetes, the COVID-19 pandemic caused a significant increase in mortality — 1.5 times — among patients with diabetes, mainly due to acute cardiovascular accidents, stroke, as well as accelerating the progression of chronic complications of diabetes, in particular chronic kidney disease.

1. World Health Organization. Coronavirus disease (COVID-2019) situation reports. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

2. Glybochko PV, Fomin VV, Avdeev SV, et al. Clinical characteristics of 1007 intensive care unitpatients with SARS-CoV-2 pneumonia. Clin Pharmacol Ther. 2020;29(2):21-29. (In Russ.). doi: https://doi.org/10.32756/0869-5490-2020-2-21-29

3. Mokrysheva NG, Galstian GR, Kirzhakov MA, et al. Rekomendatsii dlia vrachei po lecheniiu endokrinnykh zabolevanii v usloviiakh pandemii COVID-19. Moscow: NMITs endokrinologii, 2020. (In Russ.). Доступно по: https://www.endocrincentr.ru/rekomendacii-dlya-vrachey-polecheniyu-endokrinnyh-zabolevaniy-v-usloviyah. Ссылка активна на 08.08.2022.

4. Shestakova MV, Vikulova OK, Isakov MА, Dedov II. Diabetes and COVID-19: analysis of the clinical outcomes according to the data of the russian diabetes registry. Problems of Endocrinology. 2020;66(1):35-46. (In Russ.). doi: https://doi.org/10.14341/probl12458

5. Barron E, Bakhai C, Kar P, et al. Type 1 and type 2 diabetes and COVID-19 related mortality in England: a whole population study. Available from: https://www.england.nhs.uk/wp-content/uploads/2020/05/ValabhjiCOVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf

6. Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020;14(4):813-821. doi: https://doi.org/10.1177/1932296820924469

7. Zhu L, She Z-G, Cheng X, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Preexisting Type 2 Diabetes. Cell Metab. 2020;31(6):1068-1077.e3. doi: https://doi.org/10.1016/j.cmet.2020.04.021

8. Available from: www.covid19.who.int. Accessed 08.08.2022.

9. Guan WJ, Ni ZY, Hu Y, et al. China medical treatment expert group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: https://doi.org/10.1056/NEJMoa2002032

10. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia — a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403. doi: https://doi.org/10.1016/j.dsx.2020.04.018

11. Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8(6):546-550. doi: https://doi.org/10.1016/S2213-8587(20)30152-23

12. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280.e8. doi: https://doi.org/10.1016/j.cell.2020.02.052

13. Mali SN, Thorat BR, Chopade AR. A Viewpoint on AngiotensinConverting Enzyme 2, Anti-Hypertensives and Coronavirus Disease 2019 (COVID-19). Infect Disord - Drug Targets. 2021;21(3):311-313. doi: https://doi.org/10.2174/1871526520666200511005546

14. Alieva AV, Khaidarova FA. Giperglikemii u patsientov, gospitalizirovannykh po povodu COVID-19-assotsiirovannoi pnevmonii. Zhurnal teoreticheskoi i klinicheskoi meditsiny. 2020;4:178-181. (In Russ.).

15. Li J, Wang X, Chen J, et al. COVID‐19 infection may cause ketosis and ketoacidosis. Diabetes, Obes Metab. 2020;22(10):1935-1941. doi: https://doi.org/10.1111/dom.14057

16. Goldman N, Fink D, Cai J, et al. High prevalence of COVID-19-associated diabetic ketoacidosis in UK secondary care. Diabetes Res Clin Pract. 2020;166:108291. doi: https://doi.org/10.1016/j.diabres.2020.108291

17. Pal R, Banerjee M, Yadav U, Bhattacharjee S. Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature. Diabetes Metab Syndr Clin Res Rev. 2020;14:1563-1569. doi: https://doi.org/10.1016/j.dsx.2020.08.015