JMIR Publications

ABSTRACT

Background:

Type 2 diabetes mellitus is a well-established risk factor for severe complications and poor outcomes in patients with coronavirus disease-19. Patients with Type 2 Diabetes mellitus who contract Coronavirus disease-19 are at increased risk for hospitalization, intensive care unit admission, and mortality. Cardiovascular complications, including myocardial injury, arrhythmias, and thromboembolic events, have also been reported at higher rates in patients with Coronavirus disease-19. However, it remains unclear whether patients with Type 2 Diabetes mellitus who contract Coronavirus disease-19 present with distinct cardiovascular symptoms compared with non-diabetic patients. Understanding these differences may help guide early diagnosis and tailored management strategies for this high-risk population.

Objective:

Considering the increased severity and mortality associated with COVID-19 infection in diabetes patients, we investigated whether the presence of diabetes affected the number and character of presenting symptoms.

Methods:

This retrospective, observational study evaluated patients with acute COVID-19 infection who presented to the Emergency Department of one of the teaching hospital with cardiac symptoms, including chest pain/pressure, shortness of breath, palpitations, and left arm pain between 7/1/2021-12/31/2021. Patients with acute COVID-19 infection who presented to the ED with the ICD-10 codes of Chest Pain/Chest Pressure: R07.89, R07.9, R07.1, R07.81, R07.2, I25.119, I25.9, I20.9, I20.8, Shortness of Breath: R06.02, Palpitation: R00.2, R00.0, or Left arm pain: M79.602, M79.622 were included in our analysis. Demographic information - including age, gender, ethnicity – chief complaint at presentation, and ED disposition were extracted. Hemoglobin A1c was obtained for all patients. This study received approval from the Institutional Review Board.

Results:

Baseline characteristics of the study population are listed in Table 1. A total of 5,574 patients presented to the UTSW ED in the setting of acute COVID-19 infection. 2077 patients (37%) had a history of T2DM, with a mean hemoglobin A1C of 7.04%. The mean patient age was 51; 43% of patients were male. There was an even distribution of white, non-Hispanic/ Latino, and Hispanic/Latino patients noted. In terms of presenting symptom/chief complaint, shortness of breath (48%) and chest pain (45.6%) were the most common presenting symptoms, with palpitations (3.2%) and arm pain (3.1%) noted less frequently. There was an increased incidence of presenting symptoms in those with T2DM compared with patients without a history of T2DM (odds ratio of 4.4, which was statistically significant [p < 0.05]). Of the patients admitted to the hospital for COVID-19 infection, 17% of them had T2DM. Ultimately, 161 patients died – 45 patients (28%) had T2DM, while 116 (72%) did not have T2DM.

Conclusions:

Patients with Type 2 diabetes mellitus who contracted Coronavirus disease-19 were more likely to report cardiovascular symptoms than non-Type 2 diabetes mellitus patients, with the majority complaining of shortness of breath and chest pain. Additional studies would be helpful to verify this finding. The healthcare team should be aware of the difference in clinical presentation between Type 2 diabetes mellitus and non-Type 2 diabetes mellitus patients who contract Coronavirus disease-19 so that they may be triaged accordingly. Clinical Trial: none