[HEMOGLOBIN A1C AND MORTALITY FROM COVID-19]
Eugene Merzon1,2, Ilan Green1, Miriam Shpigelman3
1Leumit HMO, Medical Division, Tel-Aviv, Israel.
Insights
Poor glycemic control, indicated by high HbA1c levels before coronavirus disease 2019 (COVID-19) infection, significantly increases mortality risk in diabetic patients. Pre-existing cerebrovascular disease also elevates risk, while adequate vitamin D and iron levels offer protection.
Area of Science:
- Endocrinology
- Infectious Diseases
- Public Health
Background:
- Diabetes mellitus increases COVID-19 severity and mortality risk.
- Pre-infection glycemic control's impact on COVID-19 outcomes remains unclear.
- Previous research linked HbA1c > 9% to hospitalization in diabetic COVID-19 patients.
Purpose of the Study:
- To examine clinical characteristics of diabetic patients who died from COVID-19.
- To determine the association between pre-infection glycemic control and COVID-19 mortality.
- To identify predictors of COVID-19 mortality in diabetic and pre-diabetic individuals.
Main Methods:
- Retrospective collection of demographic, clinical, and laboratory data for COVID-19 patients with diabetes/pre-diabetes.
- Case-control study (1:5 ratio) comparing deceased patients with survivors, adjusting for confounders.
- Multivariate logistic regression analysis to identify risk and protective factors.
Main Results:
- 2.7% of 888 identified patients died from COVID-19.
- Deceased patients were older, had more comorbidities, higher HbA1c, and lower vitamin D and iron levels.
- High HbA1c and cerebrovascular disease increased mortality risk; normal vitamin D, iron, and eGFR > 60ml/min were protective.
Conclusions:
- Pre-infection HbA1c levels and cerebrovascular disease are significant predictors of COVID-19 mortality.
- Identifying these pre-infection parameters aids in risk stratification and prioritizing at-risk populations.
- Further research is required to elucidate the mechanisms linking poor glycemic control to COVID-19 mortality.
Introduction:
People with diabetes mellitus are at increased risk of developing a more severe disease or death when contracting coronavirus disease 2019 (COVID-19 ) but the effect of pre-COVID-19 infection glycemic control on disease outcomes is still unclear. In a previous study that we published from Leumit Health Services (LHS) including 183 patients with diabetes, pre-COVID-19 infection HbA1c>9% was associated with the need for hospitalization during the disease. In the current study we present the clinical characteristics of patients who died from COVID-19 in LHS and demonstrate a significant link to pre-infection HbA1c.
Methods:
We collected demographic, clinical and laboratory information regarding all patients insured in LHS who contracted COVID-19 between 1st February and 31st May 2020 and had diabetes or pre-diabetes. To better understand the contribution of pre-infection glycemic control on COVID-19 mortality we conducted a case control study at a 1:5 ratio between patients who had died and survivors, adjusting for age, sex and socioeconomic status.
Results:
We identified 888 patients of whom 24 (2.7%) died from COVID-19 . Patients who died were older, had more chronic disease, higher HbA1c and creatinine and lower hemoglobin, iron and vitamins B12 and D. In the case control study, patients who died had more obesity, dementia, cerebrovascular disease, congestive heart failure, use of SGLT-2 inhibitors and fewer smokers. In a multivariate logistic regression analysis we found that HbA1c and prior cerebrovascular disease significantly increased the risk of death and normal levels of vitamin D, iron and an estimated glomerular filtration rate >60ml/min were associated with a protective effect.
Conclusions:
Pre- COVID-19 HbA1c levels and prior cerebrovascular disease are associated with an increased risk of mortality. Identifying pre-infection clinical parameters which predict COVID-19 mortality may improve risk stratification and vaccine prioritization for at-risk populations. Further study is needed to understand the potential mechanism and causality of poor glycemic control on COVID-19 death.
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