The relationship between diabetes mellitus and the pattern of pulmonary involvement in COVID-19 patients

Abstract

Since its emergence in Wuhan, China in December 2019, SARS-CoV-2 has triggered a global pandemic characterized by a wide spectrum of clinical manifestations. Diabetes mellitus (DM) holds a special place among the various underlying diseases associated with worse outcomes of COVID-19. Therefore, the present study was designed to investigate the clinical characteristics and chest CT findings of hospitalized COVID-19 patients in Marand, Iran, with a specific focus on determining whether pre-existing diabetes mellitus is associated with distinct patterns of clinical findings and pulmonary involvement. This retrospective descriptive-comparative study was conducted on 553 hospitalized COVID-19 patients at Ayatollah Koh Kamari Hospital in Marand County from March 2019 to March 2022. The material used was a questionnaire, including demographic, clinical, history of diabetes mellitus, laboratory, and radiological reports from the patients' records. The mean age of the patients was 61.99±1.44 years and 57.8 percent of the patients were women. The most common comorbidities were diabetes, hypertension, and dyslipidemia. CRP was elevated in 67.6 percent of the total patients. In the total patient population, 48.6 percent of patients showed pulmonary involvement on chest CT scan. The most common distribution pattern was peripheral (39.3%), and multilobular involvement (18.1%) was the most common anatomic location of involvement; followed by the left and right lower lobes. Ground glass opacity (GGO) parenchymal involvement was the most common in the total patient population (48.8%) and was significantly more common among diabetic patients (54.9% vs. 44.9%; P = 0.02). In contrast, consolidation involvement was significantly more common in nondiabetic patients (28.3% vs. 13.5%; P < 0.01). Right upper lobe and left lower lobe involvement were also more common in non-diabetic patients (P = 0.03 each), while crazy-paving pattern and multilobular distribution did not show significant differences between groups. Previously diagnosed diabetes mellitus was associated with distinct CT patterns in COVID-19, with GGO being predominant in diabetic patients and consolidation being more characteristic of non-diabetic patients. These findings may contribute to the risk stratification and clinical management of diabetic patients with COVID-19.

Keywords: Chest CT scan, Pulmonary involvement, Diabetes mellitus, COVID-19