New Coronavirus Infection as a Factor in Increasing Carbohydrate Metabolism in the Late Post-COVID Period

Aim. To assess the frequency and risk factors of carbohydrate metabolism disorders in the post-COVID period.

Design. The retrospective study.

Materials and methods. The study using the continuous sampling method included 1969 patients hospitalized in the hospital of the Bashkir State Medical University Clinic with a confirmed diagnosis of COVID-19 in the period from April 16, 2020 to January 1, 2021. Based on the clinical, anamnestic and laboratory data of the patients, two study groups were formed. The first group included 980 people without carbohydrate metabolism disorders — 402 (41.02%) men and 578 (58.98%) women, whose median age was 54 [43; 63] years. The second group included 989 patients with newly diagnosed hyperglycemia (NDH) during inpatient treatment in the acute phase of COVID-19 — 463 (46.8%) men and 526 (53.2%) women aged 59 [49; 67] years. After discharge from the hospital, these patients were analyzed for cases of diagnosis of type 2 diabetes mellitus, impaired glucose tolerance, and impaired fasting glycemia. Prognostic models for the development of carbohydrate metabolism disorders in the post-COVID period were built.

Results. The observation period in the post-COVID period was 3.5 years, disorders of carbohydrate metabolism were established in 108 (5.5%) cases, including newly diagnosed T2DM in 61 (3.1%) patients and prediabetes in 47 (2.4%) people. In patients with New-Onset hyperglycemia in the acute phase of COVID-19, the prevalence of disorders of carbohydrate metabolism in the remote post-COVID period was 3 times higher than in individuals with normoglycemia, including T2DM (4.95 and 1.22%, respectively, p < 0.0001) and prediabetes (3.24 and 1.53%, respectively, p < 0.0001). In order to identify risk factors for the development of disorders of carbohydrate metabolism in the post-COVID period the initial clinical, anamnestic and laboratory-instrumental characteristics of patients were studied. The reliable parameters obtained during the comparison using the Mann-Whitney method and subsequent univariate logistic analysis were included in the regression model of multivariate analysis, where the following indicators were defined as independent predictors of carbohydrate metabolism disorders: age, venous plasma glucose level upon hospitalization, and history of arterial hypertension. As a result of the analysis, predictors of the development of carbohydrate metabolism disorders were established separately for patients with normoglycemia and newly diagnosed hyperglycemia in the acute period of COVID-19. It has been established that in patients with normoglycemia, risk factors for the development of disorders of carbohydrate metabolism in the post-COVID period are age over 62 years, erythrocyte sedimentation rate above 35 mm/h, Charlson comorbidity index greater than 1 point and C-reactive protein level greater than 30 mg/l. In individuals with newly diagnosed hyperglycemia, independent predictors were fasting venous plasma glucose level over 8.6 mmol/l upon hospitalization and body mass index (BMI) over 29.2 kg/m². A model with maximum predictive ability was constructed, including both predictors, its sensitivity was 43.04%, specificity — 79.37%.

Conclusion. New-onset hyperglycemia in the acute phase of COVID-19 can be considered as a kind of indicator of high risk of developing T2DM and prediabetes in the post-COVID period. Risk factors for carbohydrate metabolism disorders in the late post-COVID period in patients with new onset hyperglycemia in the acute phase of COVID-19 are hyperglycemia > 8.6 mmol/L and BMI > 29.22 kg/m2 upon hospitalization. The study of the long-term effects of the new coronavirus infection and the search for prognostic markers are urgent healthcare tasks, the solution of which will minimize post-COVID complications and disability of patients.

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