# The Association Between Diabetes and the Outcome of COVID-19 Infection in Bethlehem, Palestine: A Case–Control Study

## TL;DR

This study finds that diabetic patients in Palestine have a higher risk of severe outcomes from COVID-19 compared to non-diabetic patients.

## Contribution

This is the first study to investigate the relationship between diabetes and severe COVID-19 outcomes in Palestine.

## Key findings

- Diabetic patients had a 1.63 times higher risk for COVID-19 infection compared to non-diabetic patients.
- Age, hypertension, kidney diseases, and certain biomarkers were associated with severe COVID-19 outcomes.
- Gender, cardiovascular diseases, and liver function tests were not linked to severe outcomes.

## Abstract

The severity of COVID-19's outcomes has been positively correlated with an increased risk of respiratory failure and death, especially in patients with chronic illnesses. This case–control design study aims to examine the correlation in the Palestinian population in light of its impact on diabetic patients. The study was conducted from March 2020 to June 2021 on 417 patients admitted to the Palestinian National Center for Rehabilitation. Of them, 198 cases were tested positive for COVID-19 and had diabetes, whereas the remaining 219 were those who tested positive for COVID-19 but were not diagnosed with diabetes and acted as controls. Data from patient files were collected to address the study questions. Patients' ages ranged from 17 to 98 years, with a mean age of 58. Male participants represented 53.5% of the total. The results of the current study indicated that the case fatality rate (CFR) was 14.2% for all participants and 19.7% for patients with diabetes. In regard to patients' health conditions, 5.7% had cardiovascular diseases (CVD), 33.6% had hypertension, 6.5% had kidney diseases, and 47.4% had diabetes. According to the multivariate analysis, diabetic patients had a 1.63 times higher risk for COVID-19 infection compared to nondiabetic patients (adjustment of odds ratio of 1.63 and confidence interval [CI] = 0.354–1.856). This is the first study to investigate the relationship between the severity of COVID-19 outcomes in Palestine and the diabetes status, and the majority of its findings are consistent with other research studies that assessed the impact of COVID-19 on diabetic patients (with minor variations in the number and percentage). The study confirms that along with diabetes, age, hypertension, kidney diseases, shortness of breath, requirement of oxygen, D-dimer, C-reactive protein (CRP), kidney function test (KFT), and days of hospitalization were also associated with severe COVID-19 outcomes, whereas gender, CVDs, and liver function test (LFT) were not associated with severe COVID-19 outcomes.