Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID‐19

Abstract

Background Identification of risk factors of severe Covid‐19 is critical for improving therapies and understanding SARS‐CoV‐2 pathogenesis. Methods We analyzed 184 patients hospitalized for Covid‐19 in Livingston, New Jersey for clinical characteristics associated with severe disease. Results The majority of Covid‐19 patients had diabetes mellitus (DM) (62.0%), Pre‐DM (23.9%) with elevated FBG, or a BMI > 30 with normal HbA1C (4.3%). SARS‐CoV‐2 infection was associated with new and persistent hyperglycemia in 29 patients, including several with normal HbA1C levels. Forty‐four patients required intubation, which occurred significantly more often in patients with DM as compared to non‐diabetics. Conclusions Severe Covid‐19 occurs in the presence of impaired glucose metabolism in patients, including those with DM, PreDM and obesity. Covid‐19 is asociated with elevated FBG and several patients presented with new onset DM or in DKA. The association of dysregulated glucose metabolism and severe Covid‐19 suggests that SARS‐CoV‐2 pathogenesis involves a novel interplay with glucose metabolism. Exploration of pathways by which SARS‐CoV‐2 interacts glucose metabolism is critical for understanding disease pathogenesis and developing therapies. This article is protected by copyright. All rights reserved.

COVID-19 and Diabetes: A Collision and Collusion of Two Diseases

“…Finally, prediabetes, characterized by elevated fasting blood glucose or impaired insulin sensitivity, has been mostly overlooked in COVID-19 studies, but could nevertheless pose a threat to clinical outcomes (Box 1). In a US study of 184 patients, most had diabetes (62.0%) or prediabetes (23.9%), and stratifying patients solely by elevated fasting blood glucose or HbA1c increased the risk of intubation (35). A China study also found that elevated fasting blood glucose (>7.54 mmol cut-off) independently predicted mortality (HR 1.19) (26).…”

Endocrinology and Covid-19: A Multifaceted Interaction

“…19,20 Uncontrolled hyperglycemia has been linked to increased morbidity and worse outcomes in recent studies. 21 Severe COVID-19 infection may result in significant hyperglycemia not only in those with pre-existing diabetes but also in patients who have prediabetes, obesity or no previous risk factors. This is due to multiple mechanisms: increased secretion of counter-regulatory hormones, increased inflammatory response, medications such as glucocorticoids, inotropes and dextrose-containing fluids, inadequate and unpredictable oral intake, and a direct effect of SARS-CoV-2 on pancreatic islets.…”

“…This is due to multiple mechanisms: increased secretion of counter-regulatory hormones, increased inflammatory response, medications such as glucocorticoids, inotropes and dextrose-containing fluids, inadequate and unpredictable oral intake, and a direct effect of SARS-CoV-2 on pancreatic islets. 21 The management of hyperglycemia in infected individuals follows the general principles of hyperglycemia management during acute illness. [22][23][24] Regular point-of-care blood glucose monitoring is recommended in all sick patients including those with pre-existing diabetes.…”

High admission blood glucose is an independent risk factor of poor prognosis in COVID-19: A systematic review and dose-response meta-analysis

“…The initial search yielded 1177 articles, of which 636 were deduplicated and 482 were excluded following title and abstracts screening, resulting in the retrieval of 59 records for full-text assessments-among which 13 Table S4). In quantitative analysis, 10 studies were excluded as seven [18][19][20][21][22][23][24] only reported P-value and three [25][26][27] reported different effect measures.…”

“…From 35 included studies, more than half were conducted in China (23 studies), while the others were five each in America 18,21,[27][28][29] and Europe 20,25,[30][31][32] , and one each in Hong Kong 33 and South Korea 34 . FBG was utilized in 23 studies, while RBG in 13 studies.…”