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Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome
Vagisha Sharma1, Kushal Kriplani2, Isha P Tuli3
1Intern Doctor, Department of ENT, Vardhaman Mahaveer Medical College and Safdarjung Hospital, Delhi, India.
Introduction:
Mucormycosis mostly targets immunocompromised patients or those with uncontrolled diabetes but is now an important complication after coronavirus disease 2019 (COVID-19) infection. The stage of mucormycosis at presentation greatly impacts its treatment course and prognosis. Prior research has failed to evaluate an association of patient factors, especially glycated hemoglobin (HbA1c) levels and random blood sugar (RBS) at presentation, with the stage and outcome of mucormycosis.
Objectives:
To investigate the relationship between glycemic control and the stage of mucormycosis at presentation and to investigate various factors affecting mucormycosis outcome.
Materials And Methods:
All patients with clinicopathologically confirmed mucormycosis presenting to Safdarjung Hospital, New Delhi, during the COVID-19 pandemic were enrolled in the study. A questionnaire consisting of demographic information, comorbidities, history, and treatment of COVID-19 and diabetes was filled out at the time of admission. Blood glucose and HbA1c levels at presentation were noted. The above-noted parameters were compared with the stage and outcome of mucormycosis. The data obtained was analyzed.
Results:
A total of 75 mucormycosis patients were enrolled in the study. The mean age of the participants was 45.17 years, and 85.33% of them survived the disease course. There was no statistically significant difference between the survivors and nonsurvivors concerning mean HbA1c and RBS levels. But there was a statistically significant correlation such that the stage of mucormycosis increased with progressive worsening glycemic control markers HbA1c and RBS. The most common comorbid condition was diabetes mellitus (72%); however, only coronary artery disease in the patient was significantly correlated with mortality. A history of COVID-19 infection was reported in 67.6% of the patients, but this was not significantly associated with mortality outcomes. Patients without a history of COVID-19 reported significantly higher RBS and HbA1c levels at presentation than the COVID-19-associated mucormycosis group.
Conclusion:
The study showed a positive correlation between the stage of mucormycosis and serum glycemic control markers at presentation. Clinicians must order blood sugar and HbA1c levels at presentation as cues for a better understanding of disease severity. A thorough clinical examination and history taking for patient risk factors predisposing to mucormycosis are also crucial since the presence of proptosis and coronary artery disease are significantly correlated with the mortality outcomes. The extent of poor glycemic control at presentation was not associated with mortality outcomes. How to cite this article: Sharma V, Kriplani K, Tuli IP, et al. Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome. J Assoc Physicians India 2023;71(9):61-66.
Insights
Poor glycemic control, indicated by high HbA1c and random blood sugar (RBS) levels, correlates with more severe mucormycosis stages. However, these markers did not predict mortality in COVID-19 patients. Early assessment of blood sugar is crucial for understanding disease severity.
Area of Science:
- Infectious Diseases
- Endocrinology
- Critical Care Medicine
Background:
- Mucormycosis, a serious fungal infection, is increasingly seen as a complication of COVID-19, particularly in immunocompromised individuals and those with uncontrolled diabetes.
- The stage at which mucormycosis presents significantly influences treatment and patient outcomes.
- Previous studies have not fully explored the link between glycemic control markers (HbA1c, RBS) and mucormycosis severity and outcomes.
Purpose of the Study:
- To examine the relationship between glycemic control (HbA1c, RBS) and the stage of mucormycosis at presentation.
- To identify factors influencing the outcome of mucormycosis, especially in the context of COVID-19.
Main Methods:
- A study involving 75 patients with confirmed mucormycosis during the COVID-19 pandemic at Safdarjung Hospital, New Delhi.
- Data collection included demographics, comorbidities, COVID-19 history, and diabetes status, alongside presenting HbA1c and RBS levels.
- Statistical analysis compared these parameters with mucormycosis stage and patient outcomes.
Main Results:
- A significant positive correlation was found between worsening glycemic control (higher HbA1c and RBS) and more advanced stages of mucormycosis.
- Diabetes mellitus was the most common comorbidity (72%). Coronary artery disease was significantly linked to mortality.
- While 67.6% of patients had a history of COVID-19, it was not significantly associated with mortality. Patients without COVID-19 history had poorer glycemic control at presentation.
Conclusions:
- Elevated serum glycemic markers (HbA1c, RBS) at presentation correlate with increased mucormycosis stage, aiding in severity assessment.
- Clinical examination and risk factor assessment, including proptosis and coronary artery disease, are vital for predicting mortality.
- Despite the correlation with disease stage, poor glycemic control itself was not directly linked to mortality outcomes in this study.
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