Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

This study demonstrated high rates of diabetes among those hospitalized for COVID-19 in Saudi Arabia where severe vitamin D deficiency, among other factors, appeared to be a significant predictor of fatal outcome.   

Medical records from 439 people with or without diabetes mellitus (DM) who were hospitalized  from May 2020 to July 2020 for COVID-19 in Saudi Arabia were analyzed.  

• Male patients outnumbered females 2:1.  
• Three-fourths of all admitted patients whose vitamin D status were assessed had vitamin D deficiency (25(OH)D < 50 nmol/l) (74.7%).  
• Other common illnesses noted were hypertension (42.6%) and obesity (42.2%), all of which more prevalent in female than male patients.  
• The prevalence of DM was 68.3%.  
• The majority of the patients with COVID-19 had fever (75.2%), a hard time breathing (72.8%) and cough (70.0%) when they were admitted.  
• One out of every 5 patients also had nausea/vomiting (23.1%) and/or diarrhea (21.3%). 
• During hospitalization, 77 out of the 439 patients (17.5%) died. Diabetic patients had a significantly higher death rate (20.5% versus 12.3%) and lower survival time than patients that did not have diabetes.  
• Age, congestive heart failure, β-blocker use, bilateral lung infiltrates, creatinine > 90 µmol/ and vitamin D deficiency [25(OH)D < 12.5 nmol/l] were significant predictors of mortality among hospitalized COVID-19 patients.  
• Random blood glucose ≥ 11.1 mmol/l was significantly associated with intensive care admission as well as smoking, β-blocker use, neutrophil > 7.5, creatinine > 90 µmol/l and alanine aminotransferase > 65U/l. 

This article provides limited insight into some common comorbidities with COVID-19 complications, including vitamin D deficiency, that may influence COVID-19 outcomes. However, it should be considered that older patients and patients with other health issues are more likely to have diabetes and to get COVID-19 so extrapolations from this observational study are limited. It does suggest that severe vitamin D deficiency may be a risk factor for fatal outcomes from COVID-19. 

The prevalence of DM is high among hospitalized Covid-19 patients in Riyadh, Saudi Arabia. While diabetic patients have a higher mortality rate than non diabetic patients, other factors such as old age, congestive heart failure, smoking, β-blocker use, the presence of bilateral lung infiltrates, elevated creatinine and severe vitamin D deficiency, appear to be more significant predictors of mortality. Larger epidemiologic studies covering multiple institutions are needed to determine a more accurate in-hospital death rate in the country.

This study was a multicenter, double-blind, parallel-group, randomized placebo-controlled trial. The intervention group, consisting of 119 patients (41.2% female with a mean age of 56.5 years and a mean BMI of 31.9), received a single oral dose of 200,000 IU vitamin D3 dissolved in 10 ml peanut oil. Oxygen therapy was required by 72.3%  of the intervention group. The placebo group, consisting of 118 patients (46.6% female with a mean age of 56.0 years and a mean BMI of 31.4), received a single oral dose of 10 ml peanut oil only. Oxygen therapy was required by 80.5%  of the placebo group. There were no differences between the groups at baseline for ethnicity or COVID symptoms.

Alguwaihes AM, Al-Sofiani ME, Megdad M, Albader SS, Alsari MH, Alelayan A, Alzahrani SH, Sabico S, Al-Daghri NM, Jammah AA. Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study. Cardiovasc Diabetol. 2020 Dec 5;19(1):205. doi: 10.1186/s12933-020-01184-4. PMID: 33278893; PMCID: PMC7718833. https://pubmed.ncbi.nlm.nih.gov/33278893/