Evaluation and management of COVID-19-related severity in people with type 2 diabetes

Abstract

IntroductionPeople with type 2 diabetes (T2D) have an increased rate of hospitalization and mortality related to COVID-19. To identify ahead of time those who are at risk of developing severe diseases and potentially in need of intensive care, we investigated the independent associations between longitudinal glycated hemoglobin (HbA1c), the impact of common medications (metformin, insulin, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and corticosteroids) and COVID-19 severity in people with T2D.Research design and methodsRetrospective cohort study was conducted using deidentified claims and electronic health record data from the OptumLabs Data Warehouse across the USA between January 2017 and November 2020, including 16 504 individuals with T2D and COVID-19. A univariate model and a multivariate model were applied to evaluate the association between 2 and 3-year HbA1c average, medication use between COVID-19 diagnosis and intensive care unit admission (if applicable), and risk of intensive care related to COVID-19.ResultsWith covariates adjusted, the HR of longitudinal HbA1c for risk of intensive care was 1.12 (per 1% increase, p<0.001) and 1.48 (comparing group with poor (HbA1c ≥9%) and adequate glycemic control (HbA1c 6%–9%), p<0.001). The use of corticosteroids and the combined use of insulin and metformin were associated with significant reduction of intensive care risk, while ACEIs and ARBs were not associated with reduced risk of intensive care.ConclusionsTwo to three-year longitudinal glycemic level is independently associated with COVID-19-related severity in people with T2D. Here, we present a potential method to use HbA1c history, which presented a stronger association with COVID-19 severity than single-point HbA1c, to identify in advance those more at risk of intensive care due to COVID-19 in the T2D population. The combined use of metformin and insulin and the use of corticosteroids might be significant to prevent patients with T2D from becoming critically ill from COVID-19.

Assisting individuals with diabetes in the COVID-19 pandemic period: Examining the role of religious factors and faith communities

“…Coronaviruses, which are human pathogens, interact with target cells via the angiotensin-converting enzyme whose expression may be increased in diabetics' epithelial cells and intestines, kidneys, and blood vessels[ 10 ]. COVID-19 infection and subsequent development of severe disease have been associated with individuals with T2D[ 31 , 32 ]. There is evidence that COVID-19 may increase the risk of hospitalization and mortality in individuals with T2D[ 31 , 33 ].…”

“…COVID-19 infection and subsequent development of severe disease have been associated with individuals with T2D[ 31 , 32 ]. There is evidence that COVID-19 may increase the risk of hospitalization and mortality in individuals with T2D[ 31 , 33 ]. It has been determined that T2D is a sole risk factor for COVID-19 severity[ 34 ].…”

Diabetes, Metformin and the Clinical Course of Covid-19: Outcomes, Mechanisms and Suggestions on the Therapeutic Use of Metformin

“…Registry studies have identified hyperglycaemia at admission as a significant, independent predictor of Covid-19 hospitalisation or mortality ( O'Malley et al, 2021 ; Carrasco-Sánchez et al, 2021 ). The severity of hyperglycaemia appears to influence prognosis, appreciating that blood glucose can rise quickly during Covid-19 infection as seen with plasma glucose measurements but not with the gradual effect on HbA1c ( Zhang Q. et al, 2020 ; Wang B. et al, 2021 ; Ling et al, 2021 ). Hyperglycaemia is associated with adverse Covid-19 outcomes whether or not patients have diabetes ( Cai et al, 2020 ; Carrasco-Sánchez et al, 2021 ), with some suggestion of a more severe effect on Covid-19 prognosis for newly-diagnosed versus pre-existing diabetes, possibly associated with depressed respiratory function ( Aggarwal et al, 2020 ; Fadini et al, 2020 ).…”

The patient-centered diabetes management during the COVID-19 pandemic

“…In the diabetic state, the RAS is activated in the pancreas, and angiotensin II (AngII), downstream of the RAS, is strongly associated with islet dysfunction in experimental models. Angiotensin-converting enzyme 2 (ACE2) promotes the degradation of AngII into angiotensin (1)(2)(3)(4)(5)(6)(7) [Ang(1-7)] (8,9), and Ang(1-7) acts through the G protein-coupled receptor Mas and opposes many of the actions of AngII (28,29). The ACE2/Ang(1-7)/Mas axis serves as a protective and negative regulator of RAS (30).…”

“…Based on the reports thus far, diabetes does not appear to increase the risk of contracting SARS-CoV; however, when infected, the risk of hospitalization, intensive care unit (ICU) admission, and mortality increase (2,3). When patients with diabetes are managed with good glycemic control for a long period, the risk of developing severe COVID-19 is reduced (4).…”