Does the Hyperglycemia Impact on COVID-19 Outcomes Depend upon the Presence of Diabetes?-An Observational Study
Inês Manique1, Alexandra Abegão Matias1, Bruno Bouça1
1Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Hospital de Curry Cabral, 1050-099 Lisbon, Portugal.
Insights
At-admission hyperglycemia (AH) is linked to worse COVID-19 outcomes, even in patients without diabetes. Monitoring blood glucose upon admission is crucial for predicting disease severity and improving patient prognosis.
Area of Science:
- Endocrinology
- Infectious Diseases
- Critical Care Medicine
Background:
- Diabetes mellitus (DM) is a significant risk factor for severe COVID-19.
- SARS-CoV-2 infection can exacerbate glycemic control and lead to new-onset diabetes.
- At-admission hyperglycemia (AH) is a known predictor of adverse outcomes in various diseases, including COVID-19.
Purpose of the Study:
- To evaluate the impact of AH on COVID-19 clinical severity.
- To assess AH's effect regardless of pre-existing or new-onset diabetes status.
- To determine the association between AH and outcomes like respiratory support, ICU admission, and mortality.
Main Methods:
- Retrospective monocentric study of 374 COVID-19 inpatients.
- Defined AH as blood glucose > 140 mg/dL on admission or within 24 hours.
- Analyzed correlations between AH and severity outcomes (disease severity, ventilation, ICU, mortality) in diabetic and non-diabetic patients.
Main Results:
- Diabetic patients with AH showed correlations with COVID-19 severity, mechanical ventilation, and ICU admission.
- Non-diabetic patients with AH had significant associations with oxygen therapy, mechanical ventilation, and ICU admission.
- New-onset diabetes patients (all with AH) showed a trend towards severe outcomes, though not statistically significant.
Conclusions:
- AH is associated with increased COVID-19 severity and adverse outcomes, irrespective of diabetes status.
- Early assessment of glycemia in COVID-19 patients is vital for prognosis.
- Findings highlight AH as a critical factor influencing COVID-19 patient outcomes.
Abstract:
Diabetes mellitus (DM) has emerged as a major risk factor for COVID-19 severity and SARS-CoV-2 infection can worsen glycemic control and may precipitate new-onset diabetes. At-admission hyperglycemia (AH) is a known predictor for worse outcomes in many diseases and seems to have a similar effect in COVID-19 patients. In this study, we aimed to assess the impact of AH regardless of pre-existing diabetes mellitus and new-onset diabetes diagnosis in the clinical severity of COVID-19 inpatients in the first months of the pandemic. A retrospective monocentric study on 374 COVID-19 inpatients (209 males) was developed to assess associations between AH (blood glucose levels in the Emergency Department or the first 24 h of hospitalization greater than 140 mg/dL) and severity outcomes (disease severity, respiratory support, admission to Intensive Care Unit (ICU) and mortality) in patients with and without diabetes. Considering diabetic patients with AH (N = 68;18.1%) there was a correlation with COVID-19 severity (p = 0.03), invasive mechanical ventilation (p = 0.008), and ICU admission (p = 0.026). No correlation was present with any severity outcomes in diabetic patients without AH (N = 33; 8.8%). All of the New-onset Diabetes patients (N = 15; 4%) had AH, and 12 had severe COVID-19; additionally, five patients were admitted to the ICU and three patients died. However, severity outcomes did not reach statistical correlation significance in this group. In nondiabetic patients with AH (N = 51; 13.6%), there was a statistically significant association with the need for oxygen therapy (p = 0.001), invasive mechanical ventilation (p = 0.01), and ICU admission (p = 0.03). Our results support data regarding the impact of AH on severity outcomes. It also suggests an effect of AH on the prognosis of COVID-19 inpatients, regardless of the presence of pre-existing diabetes or new-onset diabetes. We reinforce the importance to assess at admission glycemia in all patients admitted with COVID-19.
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