Background: COVID-19, caused by SARS-CoV-2, emerged in December 2019 and quickly became a global public health concern. Diabetes, a major risk factor for severe COVID-19, affects 537 million people worldwide, with high prevalence in low- and middle-income countries like Pakistan. Studies show diabetes increases the risk of severe COVID-19 complications and mortality. However, there is limited data on COVID-19 outcomes in diabetic patients in Pakistan. This study aims to fill this gap and examine factors affecting outcomes in this population.

Methods: We conducted a retrospective cross-sectional study at The Aga Khan University Hospital, Karachi, encompassing 2,346 confirmed COVID-19 patients from February 26, 2020, to September 6, 2021. Data on diabetic status, following ADA guidelines and other clinical outcomes were collected from medical records and patient interviews. Statistical analysis was performed using SPSS V.25.

Results: A total of 1,342 patients were included, with 864 males (64.4%) and 478 females (35.6%). The mean age was 56.59 ± 15.55 years. SARS-CoV-2 infection was the primary diagnosis for 741 patients (55.2%), while 601 patients (44.8%) had it as a secondary diagnosis. Of the total, 348 patients (25.9%) had T2DM, 2 patients (0.15%) had T1DM, and 991 patients (73.8%) were non-diabetic. The mean duration of diabetes was 2.01 ± 1.32 years. Diabetic patients had a significantly shorter mean hospital stay (4.99 ± 4.46 days) compared to non-diabetic patients (6.79 ± 7.32 days) (p < 0.001). The overall discharge rate was 70.3%, with a mortality rate of 10.7%. T2DM was associated with lower in-hospital mortality (p < 0.001) but higher rates of ARDS (p < 0.001). There was no significant association between T2DM and the risk of pulmonary aspergillosis, pulmonary embolism, or septic shock. Higher financial class was associated with longer hospital stays and a greater likelihood of being discharged home (p < 0.001).

Conclusion: In conclusion, our study highlights the heightened susceptibility of COVID-19 patients with concurrent T1DM and T2DM to developing ARDS. Despite no significant association found between diabetes and adverse outcomes, the crucial role of tailored care for high-risk groups, particularly those with diabetes, cannot be overstated.

Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; Diabetes mellitus; In-Hospital mortality; Pakistan healthcare; SARS-CoV-2.

© 2025. The Author(s).

背景： COVID-19 是由 SARS-CoV-2 引起的，于 2019 年 12 月首次出现，并迅速成为全球公共卫生关注的问题。糖尿病是导致重症 COVID-19 的主要危险因素之一，在全世界影响着 5.37 亿人，其中低收入和中等收入国家如巴基斯坦的患病率较高。研究表明，糖尿病会增加严重 COVID-19 并发症和死亡的风险。然而，在巴基斯坦糖尿病患者中的 COVID-19 结局数据有限。本研究旨在填补这一空白，并探讨影响该人群结局的因素。

方法： 我们在卡拉奇阿迦汗大学医院进行了一项回顾性横断面研究，涵盖 2020 年 2 月 26 日至 2021 年 9 月 6 日期间确诊的 2346 名 COVID-19 患者。糖尿病状况、ADA 指南遵循情况及其他临床结局的数据均从病历和患者访谈中收集。使用 SPSS V.25 进行统计分析。

结果： 共纳入 1342 名患者，其中男性 864 名（64.4%），女性 478 名（35.6%）。平均年龄为 56.59 ± 15.55 岁。SARS-CoV-2 感染是 741 名患者（55.2%）的主要诊断，而 601 名患者（44.8%）将其作为次要诊断。在总数中，348 名患者（25.9%）患有 2 型糖尿病（T2DM），2 名患者（0.15%）患有 1 型糖尿病（T1DM），991 名患者（73.8%）是非糖尿病患者。平均病程为 2.01 ± 1.32 年。糖尿病患者的平均住院时间显著短于非糖尿病患者（4.99 ± 4.46 天 vs 6.79 ± 7.32 天，p

结论： 总的来说，我们的研究强调了同时患有 T1DM 和 T2DM 的 COVID-19 患者更容易发展成 ARDS。尽管没有发现糖尿病与不良结局之间存在显著关联，但对高危群体进行个性化护理的重要性不容忽视。

关键词： 急性呼吸窘迫综合征 (ARDS)；COVID-19；糖尿病；院内死亡率；巴基斯坦医疗保健；SARS-CoV-2。