Iranian patients with diabetes and COVID-19-associated mucormycosis: Characteristics, manifestations, and mortality risk factors

Objective This study evaluated the mortality risk factors in Iranian patients with diabetes mellitus (DM) and COVID-19-associated mucormycosis (CAM).Methods This retrospective study was conducted on confirmed CAM cases with DM. Only patients with a confirmed history of COVID-19 within the last 3 months were included. The patients were divided into the survived and deceased groups, and each group's characteristics were studied and compared. Patients were also studied according to their DM status (known or unknown case).Results A total of 106 patients were included. The mortality rate was 25.5%. The most common underlying disease (hypertension, 41.5%) was significantly higher in the deceased group. Sixty-five patients (62.5%) were known cases of DM. The mean duration of DM was 12.46 years. There was a significant relationship between the DM history and mortality rate (84.6% vs. 15.4%, p = 0.007). The history of ICU admission was 8 times higher in unknown DM patients (p = 0.011, OR = 8.000, CI = 1.60-39.95). The mean HbA1C was significantly different in known DM cases (9.36 +/- 2.03 vs. 8.02 +/- 2.40, p = 0.004). The mean first day FBS, mean first BS in emergency room, and mean FBS on the first hospitalization week were 171, 202, and 167.2 mg/dL, respectively. Although mortality was significantly related to hyperglycemic state of fasting and non-fasting BS levels (p < 0.05), it was not related to HbA1C.Conclusion Patients with diabetes and COVID-19 had uncontrolled fasting and non-fasting glucose levels during mucormycosis episode. Hypertension, history of DM, and the lack of glucose control during recent hospitalization can be associated with a poor outcome.