Keywords
coronavirus disease
immunity
blood subpopulation composition
VNL inflammatory index
immunophenotype of blood lymphocytes
How to Cite
Abstract
Today, there is a dramatic global increase in the incidence of diabetes mellitus
(DM), one of the most common diseases worldwide and non-infectious pandemic. It has
been established that the annual growth of this disease is in a geometric progression. Over
the past 25 years, the number of people diagnosed with DM worldwide increased more
than 4 times, reaching 589 million people aged 20-79, according to the data of International
Diabetes Federation.
According to expert forecasts, this number will increase to 643 million by 2030 and to
783 million by 2045. Approximately 90% of all patients suffering from this disease are
patients with type 2 diabetes (T2D). A similar progressive increase in the incidence of DM
is observed in Ukraine too. The coronavirus pandemic has had a global impact on human
health worldwide, including the endocrine system, causing significant disruptions due
to an unprecedented increase in mortality and morbidity. The data obtained confirm that
the onset of T2D in post-COVID period is characterized with significant impairments in
innate and adaptive immunity, necessitating immediate study and a thorough fundamental
understanding of the general pathophysiology and clinical and immunological patterns of
post-COVID pathogenesis in patients with onset of T2D with different body mass index (BMI),
which potentially determines the choice of therapeutic strategy in this category of patients.
Despite the large volume of publications devoted to the combination of COVID-19 and T2D,
these studies were mainly performed in patients with T2D with different disease durations.
At the same time, published data on the leukocyte composition, the VNL inflammatory index
(the ratio of the absolute number of neutrophils to the absolute number of lymphocytes),
and the subpopulation composition of lymphocytes in the peripheral blood (PB) in patients
with the debut of T2D in the post-COVID period are extremely limited and contradictory.
Blood subpopulation composition indicators are currently among the key characteristics
of immune function. These parameters are particularly important in patients with newly
diagnosed T2D in the post-COVID period. However, data on leukocyte composition, VNL
parameters, and lymphocyte immunophenotype in patients with newly diagnosed T2D with
different BMI in the post-COVID period are extremely limited and debatable. Information on
the relationship between systemic inflammatory markers and BMI parameters in patients with
newly diagnosed T2D in the post-COVID period is virtually nonexistent. Thus, the objective
of the study was to investigate the total leukocyte count, the leukocyte composition of the
PB, the VNL inflammation index, and determine the lymphocyte immunophenotype (CD3+T,
CD4+T, CD8+T, CD20+, and CD56+ cells) in the blood of patients with newly diagnosed T2D
with different BMI on the background of a history of COVID. Materials and methods. The
study included 98 patients with onset of T2D within 3 months of COVID-19, with varying
BMI, and 94 patients with onset of T2D with varying BMI and disease manifestation in the
pre-pandemic period. The comparison groups consisted of 93 normoglycemic individuals
with varying BMI after COVID-19 and 88 normoglycemic individuals with varying BMI and
without COVID-19 in anamnesis. Results. It was established that for patients with the debut
of T2D and different BMI in post-COVID, compared to patients with newly diagnosed T2D
and different BMI in the pre-COVID period, significant leukocytosis (an increase in the total
number of leukocytes by almost 1.5 times, p <0.001), neutrophilosis (an increase in the
absolute number of neutrophils by almost 2.0 times, p<0.001), monocytosis (an increase
in the absolute number of monocytes by almost 2.0 times, p <0.001), lymphopenia (a
decrease in the relative number of lymphocytes by almost 2.0 times, p<0.001) and an
increase in the VNL inflammatory index by more than 2.0 times in patients with the debut
of T2D after coronavirus disease were likely characteristic. Similar changes in the leukocyte
composition, which were found in patients with the debut of T2D and different BMI in the
post-COVID period, but less significant, were also observed in normoglycemic individuals
with different BMI in the post-COVID period and were completely absent in normoglycemic
people with different BMI in the pre-COVID period, which indicates the key importance of the
changed post-COVID state of immunity in the pathogenesis of the debut of T2D in patients
with different BMI after a previous coronavirus disease. For patients with T2D in the post-
COVID period, a decrease in the absolute number of all lymphocyte subpopulations is likely
characteristic compared to patients in the pre-COVID period and groups of normoglycemic
individuals in the pre-COVID and post-COVID periods. When distributing patients depending
on BMI into 4 subgroups: 1) 25.5 kg / m2; 2) 25.9-29.9 kg / m2; 3) 30.0-34.9 kg / m2; 4) >
35.0 kg/m2– a progressive decrease in CD3+ T-, CD4+ T-, D8+ T-, CD20+- and CD56+-cells
was revealed compared to patients with newly diagnosed T2D in the pre-COVID period,
in whom, on the contrary, a progressive increase in all lymphocyte subpopulations was
noted. A similar increase in the absolute number of CD4+ T cells depending on BMI was
also noted in normoglycemic individuals, but it was less pronounced. Conclusion. Changes
in the leukocyte composition and lymphocyte subset composition in patients with the debut
of T2D depend not only on the BMI value, but are also due to the systemic inflammatory
state of post-COVID-19 background, which exacerbates the chronic low-grade inflammation
that forms the pathogenetic basis of DM2 debut. For patients with newly diagnosed T2D in
the post-COVID period, a decrease in the content of all lymphocyte subpopulations in the
peripheral blood is characteristic, which is most pronounced with concomitant obesity, which
indicates the immunosuppressive effect of coronavirus disease on the immune system in
patients with the debut of T2D and different BMI in the post-COVID period. The changes we
have identified in the leukocyte and subpopulation content in patients with the debut of DM2
with different BMI in the post-COVID period explain the bidirectional relationship between
DM2 and coronavirus disease and determine the strategic choice of further pathogenetic
therapy for this category of patients.
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