Poor Glycemic Control in diabetics Key to Mucormycosis Outcomes in COVID-19 patients; Masks and Oxygen Not to Blame, study finds

INDIA: The presence of diabetes mellitus with poor glycemic control was the reason for the mucormycosis pandemic. COVID vaccination provided protection against severe COVID-19 as well as against covid- associated mucormycosis, a recent study published in The Journal of Associations of Physicians of India has concluded.

Contrary to popular belief, industrial oxygen and oxygen masks were not responsible for the mucormycosis pandemic, the researchers wrote. 

The study highlights the presence of uncontrolled diabetes is the leading cause of mucormycosis and it leads to an increase in the hospital stay of the patient. A long follow-up is required for patients suffering from COVID with transient diabetes.

Transient diabetes is also known as transient hyperglycemia. It refers to a temporary disruption in normal glucose metabolism, often resulting in elevated blood sugar levels that revert to normal once the underlying cause is resolved. Stress, increased cortisol levels, and consumption of beta–blockers, corticosteroids, and diuretics are the main leading causes of transient diabetes. Considering this, Prabhat Agarwal, Professor of the Department of Medicine, S.N Medical College, Agra, Uttar Pradesh, India, and colleagues aimed to determine that the Covid-19 infection spike in invasive fungal infection in the diabetic population.

For this purpose, the research team conducted a prospective cohort study with patients suffering from mucormycosis. The study was performed with the participation of 98 patients from referral hospitals in India. The study was conducted from May 20, 2021, to November 30, 2022, and the study protocol was approved by the Institutional Ethics Committee.

The patients were treated with an injection of amphotericin-B with oral posaconazole therapy, every week periodically nasal endoscopies were conducted which was coupled with radiological evaluations, and progressive debridement was carried out as required. Amphotericin B (TRAMB) injections with a dosage of 1 mL of 3.5Mg/mL solution for 5-7 days were provided to the patients with orbital lesions. Oral hypoglycemic agents and insulin were provided to the patients to maintain their strict control of blood sugar levels.

They found the following results:

• The mean age for patients was 55.5 years, with ages ranging from 28 to 88 years
• Of the patients with mucormycosis, 63.3% were male and 37.8% were female. Among them, 55.7% of the males and 58.3% of the females were known to have diabetes.
• A previous history of diabetes mellitus was found as an underlying comorbid condition in 56.7% of patients, while the remaining were diagnosed with new-onset diabetes mellitus.
• At admission, sugar levels for known diabetics ranged from 112 to 494 mg/dL, and for newly diagnosed diabetics, they ranged from 132 to 356 mg/dL. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma that was disease-free.
• The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose.
• At the 1-year follow-up, 57.7% of patients were disease-free, 30.9% had died, and 11.3% were lost to follow-up. There was a statistically significant difference in the mean glycated haemoglobin (HbA1c) levels at admission between known diabetics and newly diagnosed patients.
• By the end of 1 year, a total of seven patients from the newly diagnosed diabetic group no longer required diabetes medication.

"Patients with mucormycosis should be monitored for extended periods, as some may experience transient diabetes, especially in the context of COVID. Additionally, further epidemiological research may be necessary to understand the high incidence of mucormycosis in the Indian subcontinent," the researchers concluded. 

Reference

Agrawal, P., Singh, A. P., Chakotiya, P. S., Kumar, V., Gautam, A., & Kumar, D. (2024). Long-term Outcome of Coronavirus Disease-associated Mucormycosis: 1-year Follow-up Study from India. The Journal of the Association of Physicians of India, 72(6), 44–48. https://doi.org/10.59556/japi.72.0564