Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019

Abstract

Aims/Introduction This study aimed to explore the association between glycemic control before admission with severity and mortality of coronavirus disease 2019, and tried to reveal the mechanism. Materials and Methods A total of 77 inpatients were grouped into sufficient control group (glycated hemoglobin [HbA1c] <6.5%, n = 49) and insufficient control group (HbA1c ≥6.5%, n = 28). Regression models were used to analyze the clinical data. Results Compared with patients with HbA1c <6.5, patients with HbA1c ≥6.5 showed higher heart rate (101 vs 89 b.p.m., P = 0.012), lower percutaneous oxygen saturation (93 vs 97%, P = 0.001), higher levels of multiple indicators of inflammation, such as white blood cell count (7.9 vs 5.9 × 10 9 /L, P = 0.019), neutrophil count (6.5 vs 4.1 × 10 9 /L, P = 0.001), high‐sensitivity C‐reactive protein (52 vs 30 mg/L, P = 0.025) and serum ferritin (1,287 vs 716 μg/L, P = 0.023), as well as lower levels of lymphocyte count (0.7 vs 0.8 × 10 9 /L, P = 0.049) at hospital admission. Thus, patients with HbA1c ≥6.5 were more likely to develop secondary respiratory infections (25 [89%] vs 33 [67%], P = 0.032) and acute respiratory distress syndrome (17 [61%] vs 14 [29%], P = 0.006) than patients with HbA1c <6.5, resulting in a higher proportion of critically ill patients (19 [68%] vs 18 [37%], P = 0.009) and non‐survivors (13 [46%] vs 11 [22%], P = 0.029). After adjustment for potential risk factors, HbA1c was independently associated with in‐hospital death. Conclusion HbA1c was an independent risk factor for poor outcomes in coronavirus disease 2019 patients. Severe pulmonary infection and consequent acute respiratory distress syndrome might be the primary causes of death in insufficient glycemic control patients.

The relationship between obesity, hemoglobin A1c and the severity of COVID-19 at an urban tertiary care center in New York City: a retrospective cohort study

“… 28 Another study compared patients with an HgbA1c ≥6.5% vs patients with an HgbA1c <6.5%. 29 The study demonstrated that patients with insufficient glycemic control (HgbA1c ≥6.5%) were more likely to be critically ill, develop ARDS, and suffer from secondary respiratory infections, when compared to patients with adequate glycemic control. 29 In addition, HgbA1c itself was independently associated with mortality.…”

“… 29 The study demonstrated that patients with insufficient glycemic control (HgbA1c ≥6.5%) were more likely to be critically ill, develop ARDS, and suffer from secondary respiratory infections, when compared to patients with adequate glycemic control. 29 In addition, HgbA1c itself was independently associated with mortality. 29 With regard to hospitalised patients, additional research demonstrated that patients with strict control of blood glucose levels (glycemic variability between 3.9 and 10.0 mmol/L) had reduced mortality compared to patients with poor blood glucose control (glycemic variability greater than 10.0 mmol/L).…”

“… 29 In addition, HgbA1c itself was independently associated with mortality. 29 With regard to hospitalised patients, additional research demonstrated that patients with strict control of blood glucose levels (glycemic variability between 3.9 and 10.0 mmol/L) had reduced mortality compared to patients with poor blood glucose control (glycemic variability greater than 10.0 mmol/L). 30 These studies demonstrate the importance of having a baseline HgbA1c level and the importance of tight glycemic control for hospitalised COVID-19 patients.…”

Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection

“…However, there are some studies that have shown that higher levels of HbA1c are associated with disease progression and mortality, while few studies have not. [6][7][8][9] These results highlight the relevant role of diabetes treatment regimen and glycemic control prior to COVID-19 infection and their association with poor outcomes. In Mexico, the COVID-19 pandemic has resulted in increased mortality rates due to the high burden of cardiometabolic diseases, which facilitate the development of severe COVID-19.…”

Immune Response to SARS-CoV-2 Infection in Obesity and T2D: Literature Review

“…Milionis et al, speculates that the increase in mortality rate of diabetic patients with COVID-19, could be related to the sustained activation of chronic inflammation [ 156 ]. Patients with COVID-19 and uncontrolled diabetes mellitus, defined by HbA1C levels > 6.5%, presented excessive uncontrolled inflammatory responses and hypercoagulable state, that lead to the development of acute respiratory distress syndrome which was associated with longer hospital stay and a greater probability of death compared to well-controlled diabetic patients (HbA1c < 6.5%) [ 157 , 158 ]. Currently, diabetes management goes beyond glycated hemoglobin (HbA1C) test because it does not take into account fluctuations in blood glucose levels known as glycemic variability (GV) which has been shown to have deleterious effects associated with endothelial dysfunction, characterized by increased expression of adhesion (ICAM-1, VCAM-1) and proinflammatory molecules (IL-8, NF-κB) [ 153 , 154 , 159 ].…”