PROFILE OF DIABETES MELLITUS THERAPY IN COVID-19 PATIENTS WITH DIABETES MELLITUS AS COMORBID IN KOGABWILHAN II EMERGENCY HOSPITAL SURABAYA

Abstract

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, in December 2019 and has spread worldwide. COVID-19 spread to various countries in a short time, up to On March 11, 2020, WHO declared COVID-19 a pandemic. In May 2021, global data reported 150.989.419 confirmed cases including 3.173.576 deaths. Diabetes mellitus is one of the common comorbidities found in COVID-19 patients. Based on several studies, COVID-19 patients with diabetes mellitus tend to experienced severe clinical symptoms and a higher mortality rate.  Some factors that might play a role in increasing severity or mortality in COVID-19 patients with diabetes mellitus are the chronic inflammation state, immune dysregulation, and higher expression of furin and ACE-2 receptors. Good glycemic control had to achieve to improve the clinical outcomes in COVID-19 patients with diabetes mellitus. Providing optimal use of antidiabetic therapy along with regular blood glucose monitoring is one of the strategies that could be done to improve glycemic control. Nevertheless, research related to diabetes mellitus as a comorbidity in COVID-19 cases, especially in Indonesia, is still rarely done. Therefore, resources of information regarding recommendations for optimal diabetes mellitus treatment of choice that provide optimal effects on COVID-19 patients are still limited. This study aims to analyze the profile of diabetes mellitus therapy, patient characteristics, length of hospital stay, and clinical symptoms in COVID 19 patients with diabetes mellitus at KOGABWILHAN II Emergency Hospital in Surabaya in May-December 2020. This study is a cross-sectional analytic study. Total of 106 patients was involved in this study. Patient demographic data, clinical characteristics, profile of therapy, and length of day of treatment were analyzed descriptively and presented in tables or graphs. The relationship/correlation between research variables was analyzed using the Chi-Square and/or Spearman test; differences between variables were analyzed using the Mann-Whitney U test using SPSS version 25. Data of 106 patients showed that the most common oral antidiabetic therapy was  glimepiride [1x2mg] po 15 minutes ac, at 14.15% and combination of Glimepiride [1x2mg] po 15  minutes ac + Metformin [3x500 mg] po pc) at 3.77%. The most common insulin therapy is a combination of insulin glulisine [3x10 units, 15 minutes ac] sc and insulin detemir [14 units every night] sc at 2.83%. Based on data of 64 patients, the combination of Glimepiride 2mg (1x2 mg, 15 minutes ac) po + Metformin 500 mg (2x500 mg pc) po had the shortest median rate of change in fasting blood glucose (FBG) (2 days), with a median length of treatment days 8 days. Total of 65 patients (61.32%) in this study experienced mild symptoms of COVID-19. The most frequent clinical symptom in this study was productive cough (33.02%). Most of the patients in this study (44.34%) did not achieve a clinical outcome in the form of post-therapy FBG <130 mg/dL. A total of 59.43% of patients experienced improvement of clinical conditions with negative RT-PCR results at hospital discharge. Length of hospital stay with the highest number of patients was in the range of 6-10 days (49.06%). We conclude that the treatment of diabetes mellitus in this study had not achieved the expected therapeutic outcomes and further research is still needed to obtain optimal diabetes treatment management in COVID-19 patients with diabetes mellitus.