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Published on: July 5, 2022
HbA1c measurement may save COVID-19 inpatients from overlooked diabetes
Ayaka Yoroidaka1, Seiichiro Kurita1, Toshiyuki Kita2
1Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan.
Insights
Undiagnosed diabetes in COVID-19 patients predicts severe illness. Measuring HbA1c upon admission is crucial for identifying at-risk individuals and managing coronavirus disease 2019 (COVID-19) effectively.
Area of Science:
- Endocrinology
- Infectious Diseases
- Internal Medicine
Background:
- Diabetes mellitus is a significant comorbidity associated with increased severity and mortality in patients with coronavirus disease 2019 (COVID-19).
- A subset of COVID-19 patients may have undiagnosed or "overlooked" diabetes, potentially impacting disease progression and outcomes.
Purpose of the Study:
- To investigate the prevalence and characteristics of overlooked diabetes among hospitalized COVID-19 patients.
- To determine the association between diabetes, including newly diagnosed cases, and COVID-19 severity.
Main Methods:
- Retrospective analysis of 462 COVID-19 inpatients.
- Examination of pre-admission diabetes status, HbA1c, and blood glucose levels at admission.
- Multivariable logistic regression to identify risk factors for COVID-19 aggravation.
Main Results:
- 116 out of 462 COVID-19 patients (25.1%) had diabetes, with 40 (8.7%) diagnosed for the first time.
- Patients with diabetes were older, more likely male, had higher BMI, and lower eGFR.
- Overlooked diabetes was associated with a tendency towards more severe COVID-19 compared to pre-diagnosed diabetes.
- Diabetes was an independent predictor of COVID-19 aggravation (OR 2.15); elevated HbA1c was a risk factor in diabetic COVID-19 patients (OR 1.45).
Conclusions:
- Diabetes is a significant predictor of COVID-19 aggravation.
- High HbA1c levels in diabetic COVID-19 patients indicate a higher risk for severe disease.
- Routine HbA1c measurement in COVID-19 patients is recommended for early diagnosis and risk stratification.
Aims/Introduction:
To investigate overlooked diabetes in patients with coronavirus disease 2019 (COVID-19).
Materials And Methods:
In total, 462 COVID-19 inpatients were included in this retrospective study. The presence of diabetes before COVID-19 admission, and the HbA1c and blood glucose levels at admission were examined.
Results:
Of the 462 patients, 116 had diabetes. Seventy-six patients had been diagnosed with diabetes before COVID-19 admission, and 40 patients were diagnosed for the first time. Of the patients with diabetes 72% required insulin. Patients with diabetes were significantly (P < 0.05) older, more likely to be male, heavier, and showed a lower eGFR. Patients with overlooked diabetes showed a lower HbA1c (average 7.1% vs 7.5%), a lower casual blood glucose (average 157 vs 179 mg/dL), and they used less insulin per day during hospitalization (average 16.0 units vs 34.5 units) than patients with previously diagnosed diabetes. Patients with overlooked diabetes tended to have more severe COVID-19 than those with pre-diagnosed diabetes. Multivariable logistic regression analyses showed that the increased odds ratios (ORs) of aggravation in all patients with COVID-19 were associated with age [OR 1.04], BMI [OR 1.05], and diabetes [OR 2.15]. The risk factors for aggravation in patients with COVID-19 and diabetes were age [OR 1.05] and HbA1c [OR 1.45].
Conclusions:
Diabetes is a predictor of COVID-19 aggravation. Furthermore, in COVID-19 patients with diabetes, high HbA1c levels are a risk factor for severe COVID-19. A total of 8.7% of COVID-19 inpatients were diagnosed with diabetes after HbA1c was measured on admission. Therefore, it is important to measure HbA1c in COVID-19 patients.
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