Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19?

Abstract

Background and aim: Diabetes in often associated with an increased severity and mortality in patients with COVID-19. We aimed to find out whether the severity and mortality in patients with diabetes with COVID-19 has any correlation to the level of glycemic control. Methods: A Boolean search was made in PubMed database using the specific keywords related to our objectives up till May 14, 2020 and full text of article retrieved with the supplements published in English language. Results: Two studies available so far have studied the outcomes of severity and mortality in patients with diabetes stratified on glycemic control. Both the studies have unequivocally found that patients with poorly-controlled hyperglycemia (blood glucose >180 mg/dl) have significantly higher level of poor prognostic markers biochemically, compared to the well-controlled arms (blood glucose <180 mg/dl). Moreover, significant increase in severity and mortality was observed in cohorts with poorly-controlled blood glucose due to any cause (diabetes or stress hyperglycemia), compared to the well-controlled cohorts with COVID-19, even after the adjustment of multiple confounders. Conclusions: Poorly-controlled hyperglycemia increases the severity and mortality in patients with COVID-19. All treating physician must strive for a good glycemic control (blood glucose <180 mg/dl) in patients with or without diabetes.

Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry

“…In regard to COVID-19, elevated blood glucose(BG) levelsis also associated with in-hospital complications, including mechanicalventilation requirement, intensive care unit (ICU) admission, and death [3][4][5][6][7].Thus, hyperglycemia, particularly upon admission, could be a marker of poor prognosisregardless of diabetes status. This suggests that elevated BG may play a decisiverole in the severityof the disease at an early stage [8][9][10].…”

“…Santiago Clinical Hospital, Santiago de Compostela, Spain (8) Internal Medicine Department. Torrevieja University Hospital, Torrevieja, Spain (9) Internal Medicine Department. Nuestra Señora del Prado Hospital, Talavera de la Reina, Spain…”

Altered Self-Observations, Unclear Risk Perceptions and Changes in Relational Everyday Life: A Qualitative Study of Psychosocial Life with Diabetes during the COVID-19 Lockdown

“…However, numerous studies have shown an increased risk of severe COVID- 19 and mortality in individuals with diabetes [4,[6][7][8][9][10][11][12], as well as higher rates of hospitalization due to COVID-19 [13,14]. Thus, individuals with diabetes have been identified as having worse COVID-19 outcomes, particularly those with poor glycemic control [15,16].…”

Covid-19 and endocrinology – intersections: a review of current knowledge on physiopathological associations

“…The mortality rate was significantly higher in patients with pre-existing DM compared to non-diabetic individuals (7.8% versus 2.7%, p <0.001; adjusted risk ratio of 1.49). 25 Furthermore, after a 28-day follow-up, 528patients with pre-existing DM2 were stratified as poorly controlled diabetes (blood glucose [BG]>180mg/dl, median BG=216 mg/dL and median HbA1C = 8.1%), and 282 patients as having well-controlled diabetes (BG 70-180mg/dl, median BG=116mg/dL and median HbA1C=7.3%). Although both groups had similar baseline age, body mass index and chest computed tomography scan at admission, a lower incidence of lymphopenia, lower rates of increased leukocyte and neutrophil counts and an increase in serum CRP and procalcitonin were observed in the group with Controlled BG.There was also a significantly lower frequency of pharmacological therapy in the well-controlled BG group compared to the poorly controlled group.…”