Diabetes mellitus has been associated with negative implications including mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), and disease progression among COVID-19 patients. The aim of this study was to identify and analyze predictors of mortality, including its socio-demographic , laboratory, and clinical aspects, among diabetic patients hospitalized with COVID-19. This study employed a retrospective, analytical observational approach using descriptive statistics and binary logistic regression with a level of significance of 0.05. This involves 200 with COVID-19 and Diabetes mellitus admitted from March 1, 2020, until September 30, 2020, at a single-center tertiary hospital in the Philippines. Age (p-value=0.035) and end-organ damage (p-value=0.039) were found to be key predictors of mortality. Active cancer (p-value=0.032) and atrial fibrillation (AF) (p-value=0.027) were also important contributing factors. Additionally, acute respiratory distress syndrome (ARDS) (p-value=0.030) and septic shock (p-value < 0.001) also showed marked increased risk of mortality among patients. Overall, this study identified age, number of end-organ damage, active cancer, AF, ARDS, and septic shock as important predictors of mortality among COVID-19 patients with Diabetes mellitus, emphasizing the necessity of focused management approaches in this high-risk group.

Keywords. COVID-19 complications, Mortality, Diabetes mellitus, End-organ damage, Comorbidities

1. Huang et. al, Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia e A systematic review, meta- analysis, and meta-regression, 2020 Diabetes India. Published by Elsevier Ltd.
2. World Health Organization , https://www.who.int/emergencies/diseases/novel-coronavirus2019?gclid=EAIaIQobChMI_oirruik6wIVtsEWBR0WswzrEAAYASAAEgJfAvD_BwE
3. Julian Peto et. al., Ethnicity and COVID-19: An Urgent Public Health Research Priority , www.thelancet.com Vol 395 May 2, 2020
4. Philippine Department of Health, https://covid19.healthypilipinas.ph/updates-covid
5. Ma RCW, Holt RIG. COVID-19 and diabetes. Diabet Med 2020. https://doi.org/ 10.1111/dme.14300.
6. Pal R, Bhansali A. COVID-19, diabetes mellitus and ACE2: the conundrum. Diabetes Res Clin Pract 2020;162:108132. https://doi.org/10.1016/ j.diabres.2020.108132.
7. Jafar N, Edriss H, Nugent K. The effect of Short-term hyperglycemia on the innate immune system. Am J Med Sci 2016;351:201e11. https://doi.org/ 10.1016/j.amjms.2015.11.011.
8. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long Structural studies of SARS coronavirus. J Virol 2020;94:1e9.
9. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020;8: e21. https://doi.org/10.1016/S2213-2600(20)30116-8.
10. Romaní-Pe rez M, Outeirin~o-Iglesias V, Moya CM, Santisteban P, Gonza lez- Matías LC, Vigo E, et al. Activation of the GLP-1 receptor by liraglutide in- creases ACE2 expression, reversing right ventricle hypertrophy, and improving the production of SP-A and SP-B in the lungs of type 1 diabetes rats. Endocrinology 2015;156:3559e69. https://doi.org/1210/en.2014- 1685.
11. Moghissi ES, Korytkowski MT, Dinardo MM et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009; 32(6):1119-1131.
12. Umpierrez GE, Hellman R, Korytkowski MT et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97(1):16-38.
13. Yvonne A. Dei-Adomakoh, Steroid-induced Dysglycaemia in Patients with Haematological Disorders : A Ten-Year Review in a Tertiary Hospital in Ghana, Ghana Medical Journal, Volume 53 Number 2 June 2019
14. GR Bernard, The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination, time
15. Wim Van Biesen, Raymond Vanholder and Norbert Lameire, Defining Acute Renal Faliure: RIFLE and Beyong , Clinical Journal of the American Society of Nephrology , November 2006
16. Y.M Gao et al, Cytokine StormSyndrome in Covid -19, Journal of Internal Medicine , 2020
17. Philippine Society of Infectious Disease: INTERIM GUIDELINE ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED AND CONFIRMED CoVID-1 Version 2.1, os of 29 March 2020 1
18. Anupama BK, A Review of Acute Myocardial Injury in Coronavirus Disease 2019 , Cureus 12(6): e8426. Ju e3, 2020
19. Lu Xia, 1,a Jun Chen et al, The Course of Mild and Moderate COVID-19 Infections- The Unexpected Long-Lasting Challenge , Infectious Disease Society of America , July 2020
20. Toshihiro et al, Diagnostic Criteria and Laboratory Test for Disseminated Intravascular Coagulation (Japan Association of Acute Medicine criteria) , Journal of Clinical Hemopathology , Vol 51. No.2, Nov 2011.
21. Kumar, Vishnu Karan et al, Transaminitis is An Indicator of Mortaility in Patients with COVID-19: A Retrosceptive Cohort Study , World Journal of Hepatology , Sept 7, 2020
22. Sudhir Bhandari, Impact of glycemic control in diabetes mellitus on management of COVID-19 infection, International Journal of Diabetes in Developing Countries (July–September 2020)
23. Bode B, Garrett V, Messler J. Glycemic char- acteristics and clinical outcomes of COVID 19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14(4):813–21.
24. Constatino S, Paneni F, Battista R, Castello L, Capretti G, Chiandotto S. Impact of glycemic variability on chromatin remodeling, oxidative stress, and endothelial dysfunction in patients with type 2 diabetes and with target HbA1c. Diabetes. 2017;66(9):2472–82.
25. Van Cromphaut SJ. Hyperglycaemia as part of the stress response: the underlying mecha- nisms. Best Pract Res Clin Anaesthesiol. 2009; 23(4):375–86.
26. Li X, Ma X (2020) Acute respiratory failure in COVID-19: is it “typical” ARDS? Crit Care 24:1–5
27. Chidiebere V. Ugwueze, COVID-19 and Diabetes Mellitus : The Link and Clinical Implications, Dubai Diabetes and Endocrinology Journal, October 23,2020
28. Chou, M., Huang, S., Liang, C., Peng, L., Lin, Y., Hsiao, F., & Chen, L. (2021). All-cause mortality, cardiovascular mortality, major cardiovascular events and hypoglycaemia of patients with diabetes onset at an older age: results from the 10-year nationwide cohort study. Age And Ageing, 50(6), 2094–2104. https://doi.org/10.1093/ageing/afab183
29. Mokhtari, T., Hassani, F., Ghaffari, N., Ebrahimi, B., Yarahmadi, A., & Hassanzadeh, G. (2020). COVID-19 and multiorgan failure: A narrative review on potential mechanisms. Journal of Molecular Histology, 51(6), 613–628. https://doi.org/10.1007/s10735-020-09915-3
30. Esmailian, M., Vakili, Z., Nasr-Esfahani, M., Heydari, F., & Masoumi, B. (2022). D-dimer Levels in Predicting Severity of Infection and Outcome in Patients with COVID-19. Tanaffos, 21(4), 419–433.
31. Ramon, J., Llauradó, G., Güerri, R., Climent, E., Ballesta, S., Benaiges, D., López-Montesinos, I., Navarro, H., Fernández, N., Carrera, M. J., Mauricio, D., Roux, J. a. F., & Chillarón, J. (2021). Acute-to-Chronic glycemic ratio as a predictor of COVID-19 severity and mortality. Diabetes Care, 45(1), 255–258. https://doi.org/10.2337/dc21-1321
32. Aljohani, F. D., Khattab, A., Elbadawy, H. M., Alhaddad, A., Alahmadey, Z., Alahmadi, Y., Eltahir, H. M., Matar, H. M. H., & Wanas, H. (2022). Prognostic factors for predicting severity and mortality in hospitalized COVID‐19 patients. Journal of Clinical Laboratory Analysis, 36(3). https://doi.org/10.1002/jcla.24216
33. Palacios-Moguel, P., Esquivel-Pineda, A., Flores-Andrade, X. A., Aguirre-Sanchez, J. S., Cruz-Arellanes, N. N., Sauza-Sosa, J. C., García-Gonzalez, N., Manzur-Sandoval, D., Toledo-Aleman, E., & García-Cruz, E. (2023). Acute respiratory distress syndrome in patients with COVID-19 vs. Non-COVID-19: clinical characteristics and outcomes in a tertiary care setting in Mexico City. BMC Pulmonary Medicine, 23(1). https://doi.org/10.1186/s12890-023-02744-6
34. Walsh, T. J., Bright, R. A., Ahuja, A., McCarthy, M. W., Marfuggi, R. A., & Simpson, S. Q. (2022). Meeting the challenges of sepsis in Severe coronavirus Disease 2019: A call to arms. Open Forum Infectious Diseases, 10(1). https://doi.org/10.1093/ofid/ofac645
35. Cheng, Y., Luo, R., Wang, K., Zhang, M., Wang, Z., Dong, L., ... & Xu, G. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International, 97(5), 829-838. https://doi.org/10.1016/j.kint.2020.03.005
36. Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., ... & Huang, C. (2020). Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiology, 5(7), 802-810. https://doi.org/10.1001/jamacardio.2020.0950
37. Liang, W., Guan, W., Chen, R., Wang, W., Li, J., Xu, K., ... & He, J. (2020). Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. The Lancet Oncology, 21(3), 335-3 https://doi.org/10.1016/S1470-2045(20)30096-6
38. Guo, T., Fan, Y., Chen, M., Wu, X., Zhang, L., He, T., ... & Wang, H. (2020). Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiology, 5(7), 811-818. https://doi.org/10.1001/jamacardio.2020.1017
39. Yu, W., & Cheng, J. (2020). Uric acid and cardiovascular disease: an update From molecular mechanism to clinical perspective. Frontiers in Pharmacology, 11. https://doi.org/10.3389/fphar.2020.582680
40. Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., & the Northwell COVID-19 Research Consortium. (2020). Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA, 323(20), 2052-2059. https://doi.org/10.1001/jama.2020.6775