An Assessment of 25-hydroxyvitamin D Levels and Inflammation Markers in Diabetic Patients with Mild COVID-19

Abstract

Abstract Introduction: The effects of 25-hydroxyvitamin D (25(OH) D) on inflammation are gaining attention, particularly for diabetic individuals with COVID-19. Therefore, we examined 25(OH) D and inflammation-related markers in diabetic subjects with mild COVID-19. Materials and Methods: This investigation was intended to be retrospective. The present study covered the medical records of patients who applied to the our hospital between March 2020 and November 2022. All patients suffer from COVID-19. The control group (n = 30) had no diabetes, while the study group (n = 36) had diabetes. Inflammatory markers such as ferritin, C-reactive protein and erythrocyte sedimentation rate were measured in addition to 25 (OH) D levels in each subject. Also, the results of the complete blood count were obtained from the hospital database. Results: Our participants were matched in terms of gender and age between study groups. ESR, CRP, ferritin, and 25 (OH) D levels, among other variables, did not significantly differ between the non-DM and DM groups (p>0.05). Also, we evaluated all participants according to deficiency of 25 (OH) D, and inflammatory markers were not evaluated in diabetic subjects with COVID-19. However, our findings showed that ferritin levels and Hba1c levels in diabetic individuals significantly correlated positively. Conclusion: Diabetes mellitus and deficiency of 25 (OH) D are known as risk factors for COVID-19. But as compared to non-diabetic participants with COVID-19, our findings did not reveal any considerable elevation neither inflammatory markers nor changes 25 (OH) D in the diabetics.

Keywords

• 25-hydroxyvitamin D
• COVID-19
• Diabetes Mellitus
• Inflammation

An Assessment of 25-hydroxyvitamin D and Inflammation in Diabetic Patients with Mild COVID-19

Abstract

Introduction: The effects of 25-hydroxyvitamin D (25(OH)) on inflammation are gaining attention, particularly for diabetic individuals with COVID-19. Therefore, we examined 25(OH) D and inflammation-related markers in diabetic subjects with mild COVID-19. Materials and Methods: This investigation was intended to be retrospective. The present study covered the medical records of patients who applied to the Taksim training and research hospital between March 2020 and November 2022. All patients suffer from COVID-19. The control group (n = 30) had no diabetes, while the study group (n = 36) had diabetes. Inflammatory markers such as ferritin, CRP, and ESR were measured in addition to 25 (OH) D levels in each subject. Also, the results of the complete blood count were obtained from the hospital database. Results: Our participants were matched in terms of gender and age between study groups. ESR, CRP, ferritin, and 25 (OH) D levels, among other variables, did not significantly differ between the non-DM and DM groups (p>0.05). Also, we evaluated all participants according to deficiency of 25 (OH) D, and inflammatory markers were not evaluated in diabetic subjects with COVID-19. However, our findings showed that ferritin levels and Hba1c levels in diabetic individuals significantly correlated positively. Conclusion: Diabetes mellitus and deficiency of 25 (OH) D are known as risk factors for COVID-19. But as compared to non-diabetic participants with COVID-19, our findings did not reveal any considerable elevation neither inflammatory markers nor changes 25 (OH) D in the diabetics.

Keywords

• 25-hydroxyvitamin D
• COVID-19
• Diabetes Mellitus
• Inflammation

References

1. 1. Umakanthan S, Sahu P, Ranade AV, Bukelo MM, Rao JS, Abrahao-Machado LF et al. Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Postgrad Me. J. 2020 Dec;96(1142):753-758. doi: 10.1136/postgradmedj-2020-138234.
2. 2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7.
3. 3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
4. 4. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020 Jul 28;71(15):889-890. doi: 10.1093/cid/ciaa330.
5. 5. Anka AU, Tahir MI, Abubakar SD, Alsabbagh M, Zian Z, Hamedifer H, et al. Coronavirus disease 2019 (COVID‐19): An overview of the immunopathology, serological diagnosis and management. Scand J Immunol . 2021 Apr;93(4):e12998. doi: 10.1111/sji.12998.
6. 6. Yousef H, Khandoker AH, Feng SF, Helf C, Jelinek HF. In ammation, oxidative stress and mitochondrial dysfunction in the progression of type II diabetes mellitus with coexisting hypertension. Front Endocrinol (Lausanne) . 2023 Jun 13;14:1173402.doi: 10.3389/fendo.2023.1173402.
7. 7. Halim M, Halim A.  e e ects of in ammation, aging and oxidative stress on the pathogenesis of diabetes mellitus (type 2 diabetes). Diabetes Metab Syndr. 2019 MarApr;13(2):1165-1172. doi: 10.1016/j.dsx.2019.01.040. Epub 2019 Jan 24.
8. 8. Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and in ammation. Curr Diab Rep. 2013 Jun;13(3):435-44. doi: 10.1007/s11892-013-0375-y

9. 9. Cosarca MC, Hălmaciu I, Muresan AV, Suciu BA, Molnar C, Russu E, et al. Neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios are associated with amputation rates in patients with peripheral arterial disease and diabetes mellitus who underwent revascularization: A Romanian regional center study. Exp  er Med . 2022 Oct 3;24(5):703. doi: 10.3892/etm.2022.11639
10. 10. Joshi A, Bhambhani A, Barure R, Gonuguntla S, Sarathi V, Attia AM, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as markers of stable ischemic heart disease in diabetic patients: An observational study. Medicine (Baltimore). 2023 Feb 3;102(5):e32735. doi: 10.1097/MD.0000000000032735.
11. 11. Zeng J, Chen M, Feng Q, Wan H, Wang J, Yang F, et al.  e Platelet-to-Lymphocyte Ratio Predicts Diabetic Retinopathy in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2022 Nov 22;15:3617-3626. doi: 10.2147/DMSO.S378284.
12. 12. Mousa A, Misso M, Teede H, Scragg R, de Courten B. E ect of vitamin D supplementation on in ammation: protocol for a systematic review. BMJ Open. 2016 Apr 5;6(4):e010804. doi: 10.1136/bmjopen-2015-010804.
13. 13. Hernández-Álvarez E, Pérez-Barrios C, Blanco-Navarro I, Perez-Sacristan B, Donoso-Navarra E, Silvestre RA, et al. Association between 25-OH-vitamin D and C-reactive protein as a marker of in ammation and cardiovascular risk in clinical practice. Ann Clin Biochem. 2019 Jul;56(4):502-507. doi: 10.1177/0004563219851539.
14. 14. Khunti K, Del Prato S, Mathieu C, Kahn SE, Gabbay RA, Buse JB. COVID-19, hyperglycemia, and new-onset diabetes. Diabetes Care. 2021 Dec;44(12):2645-2655. doi: 10.2337/ dc21-1318
15. 15. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr n2020 Jul-Aug;14(4):535-545. doi: 10.1016/j.dsx.2020.04.044.
16. 16. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3
17. 17. Wu J, Zhang J, Sun X, Wang L, Xu Y, Zhang Y, et al. In uence of diabetes mellitus on the severity and fatality of SARS‐CoV‐2 (COVID‐19) infection. Diabetes Obes Metab. 2020 Oct;22(10):1907-1914. doi: 10.1111/dom.14105
18. 18. Robert AA, Al Saeed A, Al Dawish MA. COVID-19 among people with diabetes mellitus in Saudi Arabia: Current situation and new perspectives. Diabetes Metab Syndr. 2021 Sep-Oct;15(5):102231. doi: 10.1016/j.dsx.2021.102231.
19. 19. Rajpal A, Rahimi L, Ismail‐Beigi F. Factors leading to high morbidity and mortality of COVID‐19 in patients with type 2 diabetes. J Diabetes. 2020 Dec;12(12):895-908. doi: 10.1111/1753-0407.13085.
20. 20. Ali N. Role of vitamin D in preventing of COVID-19 infection, progression and severity. J Infect Public Health . 2020 Oct;13(10):1373-1380. doi: 10.1016/j.jiph.2020.06.021.
21. 21. Mercola J, Grant WB, Wagner CL. Evidence regarding vitamin D and risk of COVID-19 and its severity. Nutrients. 2020 Oct 31;12(11):3361. doi: 10.3390/nu12113361.
22. 22. Panagiotou G, Tee SA, Ihsan Y, Athar W, Marchitelli G, Kelly D, et al. Low serum 25‐hydroxyvitamin D (25 [OH] D) levels in patients hospitalized with COVID‐19 are associated with greater disease severity. Clin Endocrinol (Oxf). 2020 Oct;93(4):508-511. doi: 10.1111/ cen.14276.
23. 23. Singh S, Jain R, Singh S. Vitamin D deficiency in patients with diabetes and COVID-19 infection. Diabetes & Metabolic Syndrome: Diabetes Metab Syndr. 2020 September-October; 14(5): 1033–1035. doi: 10.1016/j.dsx.2020.06.071
24. 24. Wang M-K, Yu XL, Zhou LY, Si HM, Hui JF, Yang JS. Potential role of vitamin D in patients with diabetes, dyslipidaemia, and COVID-19. World J Crit Care Med. 2022 Mar 9;11(2):112-114. doi: 10.5492/wjccm.v11.i2.112.
25. 25. Di Filippo L, Allora A, Doga M, Formenti AM, Locatelli M, Querini PR, et al. Vitamin D levels are associated with blood glucose and BMI in COVID-19 patients, predicting disease severity. J Clin Endocrinol Metab. 2022 Jan 1;107(1):e348-e360. doi: 10.1210/clinem/ dgab599.
26. 26. Mittal J, Ghosh A, Bhatt SP, Anoop S, Ansari IA, Misra A. High prevalence of post COVID-19 fatigue in patients with type 2 diabetes: a case-control study. Diabetes Metab Syndr. 2021 Nov-Dec;15(6):102302. doi: 10.1016/j.dsx.2021.102302.
27. 27. Story MJ. Essential su iciency of zinc, ω-3 polyunsaturated fatty acids, vitamin D and magnesium for prevention and treatment of COVID-19, diabetes, cardiovascular diseases, lung diseases and cancer. Biochimie. 2021 Aug;187:94-109. doi: 10.1016/j.biochi.2021.05.013
28. 28. Argano C, Mallaci Bocchio R, Lo Monaco M, Scibetta S, Natoli G, Cavezzi A, et al. An Overview of Systematic Reviews of the Role of Vitamin D on In ammation in Patients with Diabetes and the Potentiality of Its Application on Diabetic Patients with COVID-19. Int J Mol Sci. 2022 Mar 6;23(5):2873. doi: 10.3390/ijms23052873.
29. 29. Asbaghi O, Sadeghian M, Moza ari-Khosravi H, Maleki V, Shokri A, Hajizadeh-Sharafabad F, et al.  e e ect of vitamin d-calcium co-supplementation on in ammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials. Cytokine. 2020 May;129:155050. doi: 10.1016/j.cyto.2020.155050.
30. 30. Malik SUF, Chowdhury PA, Hakim A, Islam MS, Alam MJ, Azad AK. Blood biochemical parameters for assessment of COVID-19 in diabetic and non-diabetic subjects: a cross-sectional study. Int J Environ Health Res. 2022 Jun;32(6):1344-1358. doi: 10.1080/09603123.2021.1879741.
31. 31. Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic in ammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract. 2020 Jun;164:108214. doi: 10.1016/j.diabres.2020.108214.