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Glycemic Control and Clinical Outcomes in U.S. Patients With COVID-19: Data From the National COVID Cohort
Rachel Wong1, Margaret Hall1, Rohith Vaddavalli2
1Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY.
Insights
Higher HbA1c levels in patients with type 2 diabetes (T2D) correlate with increased COVID-19 hospitalization risk. However, risks for death and need for ventilation plateau at specific HbA1c levels, indicating glycemic control
Area of Science:
- Endocrinology
- Infectious Diseases
- Public Health
Background:
- Type 2 diabetes (T2D) is a significant comorbidity impacting COVID-19 outcomes.
- Glycemic control, measured by HbA1c, is crucial for managing T2D complications.
- Understanding the relationship between glycemic control and COVID-19 severity is vital for patient management.
Purpose of the Study:
- To investigate the association between HbA1c levels and COVID-19 outcomes in patients with T2D.
- To determine if higher HbA1c levels correlate with increased severity of COVID-19 infection.
- To identify specific HbA1c thresholds associated with critical COVID-19 outcomes.
Main Methods:
- Retrospective observational study using the National COVID Cohort Collaborative (N3C) database.
- Inclusion criteria: adults (≥18 years) with T2D and confirmed COVID-19 infection.
- Primary outcome: 30-day mortality; secondary outcomes: invasive ventilation, ECMO, hospitalization, and length of stay.
Main Results:
- A cohort of 39,616 patients with T2D and COVID-19 was analyzed.
- Increasing HbA1c levels were associated with a higher risk of hospitalization.
- Risk of death and need for invasive ventilation/ECMO plateaued at HbA1c levels >8% and >9%, respectively.
Conclusions:
- In patients with T2D and COVID-19, elevated HbA1c levels increase hospitalization risk.
- While mortality and ventilation risks rise with HbA1c, they stabilize at higher glycemic levels.
- Effective glycemic control in T2D may mitigate severe COVID-19 outcomes, though thresholds exist for risk plateauing.
Objective:
The purpose of the study is to evaluate the relationship between HbA1c and severity of coronavirus disease 2019 (COVID-19) outcomes in patients with type 2 diabetes (T2D) with acute COVID-19 infection.
Research Design And Methods:
We conducted a retrospective study using observational data from the National COVID Cohort Collaborative (N3C), a longitudinal, multicenter U.S. cohort of patients with COVID-19 infection. Patients were ≥18 years old with T2D and confirmed COVID-19 infection by laboratory testing or diagnosis code. The primary outcome was 30-day mortality following the date of COVID-19 diagnosis. Secondary outcomes included need for invasive ventilation or extracorporeal membrane oxygenation (ECMO), hospitalization within 7 days before or 30 days after COVID-19 diagnosis, and length of stay (LOS) for patients who were hospitalized.
Results:
The study included 39,616 patients (50.9% female, 55.4% White, 26.4% Black or African American, and 16.1% Hispanic or Latino, with mean ± SD age 62.1 ± 13.9 years and mean ± SD HbA1c 7.6% ± 2.0). There was an increasing risk of hospitalization with incrementally higher HbA1c levels, but risk of death plateaued at HbA1c >8%, and risk of invasive ventilation or ECMO plateaued >9%. There was no significant difference in LOS across HbA1c levels.
Conclusions:
In a large, multicenter cohort of patients in the U.S. with T2D and COVID-19 infection, risk of hospitalization increased with incrementally higher HbA1c levels. Risk of death and invasive ventilation also increased but plateaued at different levels of glycemic control.
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