Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19

Abstract

Aim To evaluate the association between different degrees of hyperglycaemia and the risk of all‐cause mortality among hospitalized patients with COVID‐19. Materials and Methods In a retrospective study conducted from 22 January to 17 March 2020, 453 patients were admitted to Union Hospital in Wuhan, China, with laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 infection. Patients were classified into four categories: normal glucose, hyperglycaemia (fasting glucose 5.6‐6.9 mmol/L and/or HbA1c 5.7%‐6.4%), newly diagnosed diabetes (fasting glucose ≥7 mmol/L and/or HbA1c ≥6.5%) and known diabetes. The major outcomes included in‐hospital mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Results Patients with newly diagnosed diabetes constituted the highest percentage to be admitted to the ICU (11.7%) and require IMV (11.7%), followed by patients with known diabetes (4.1%; 9.2%) and patients with hyperglycaemia (6.2%; 4.7%), compared with patients with normal glucose (1.5%; 2.3%), respectively. The multivariable‐adjusted hazard ratios of mortality among COVID‐19 patients with normal glucose, hyperglycaemia, newly diagnosed diabetes and known diabetes were 1.00, 3.29 (95% confidence interval [CI] 0.65‐16.6), 9.42 (95% CI 2.18‐40.7) and 4.63 (95% CI 1.02‐21.0), respectively. Conclusion We showed that COVID‐19 patients with newly diagnosed diabetes had the highest risk of all‐cause mortality compared with COVID‐19 patients with known diabetes, hyperglycaemia and normal glucose. Patients with COVID‐19 need to be kept under surveillance for blood glucose screening.

Why is hyperglycaemia worsening COVID‐19 and its prognosis?

“…Hyperglycaemia, even in people without previous diabetes, has often been reported in the complicated coronavirus disease 2019 (COVID-19). 1,2 Hyperglycaemia in COVID-19 is a strong predictor of worsening the prognosis and increasing the possibility of death. 1,2 Therefore, understanding the process behind this evidence is of great interest.…”

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

“…DRMA for mortality outcome included three studies 32,35,39 as overlapping populations were detected in two studies. 35,38 We were also unable to observe any exposure-response gradients although most studies reported otherwise 35,38,39 . However, when analysis was conducted only for non-diabetic patients, we observed an elevated mortality risk of about 38% per 1 mmol/L increase (RR 1.38 [95% CI: 1.21-1.57]; Appendix Figure S4).…”

“…GRADE assessments of the prognostic value of FBG resulted in high-quality evidence for severity and moderate-quality evidence for mortality and poor outcome, whereas the remaining domains yielded very low-to-low-quality evidence. Overlapping populations were observed in four studies [35][36][37][38] (Appendix Table S7), and analyses were prioritized to Wang et al 35 due to larger sample size.…”

Admission fasting blood glucose predicts 30‐day poor outcome in patients hospitalized for COVID‐19 pneumonia

“…COVID‐19 patients with diabetes may also experience severe complications, such as ketosis, ketoacidosis or diabetic ketoacidosis 13 . Patients with newly diagnosed diabetes had poorer outcomes than those with known diabetes 14 . Acute hyperglycaemia has frequently been observed in patients without diabetes, which may be induced by a decrease of insulin secretion and the appearance/worsening of insulin resistance 15 .…”