Preinfection glycaemic control and disease severity among patients with type <scp>2</scp> diabetes and <scp>COVID‐19</scp>: A retrospective, cohort study

Hayek, Samah; Ben‐Shlomo, Yatir; Balicer, Ran D.; Byrne, Katherine; Katz, Mark A.; Kepten, Eldad; Roitman, Eytan; Zychma, Marcin; Barda, Noam

doi:10.1111/dom.14393

Cited by 12 publications

(24 citation statements)

References 20 publications

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“… 8 However, one study did indicate a significant positive association between single-point preinfection HbA1c, measured within 6 months, and the severity of COVID-19 illness. 33 In contrast to these previous investigations, our study considers a longer period glycemic control for an individual as an indicator for history of diabetes and severity (which are usually harder to evaluate) by using the 2 to 3-year longitudinal HbA1c. Here we successfully identified the 2 to 3-year longitudinal HbA1c to be a significant risk factor for COVID-19-related severity that can serve as a key clinical parameter related to management of COVID-19 for an individual patient and for assessing ICU use.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Glicksberg

Nadkarni

et al. 2021

BMJ Open Diab Res Care

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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.

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Section: Discussionmentioning

confidence: 99%

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

Wang

Glicksberg

Nadkarni

et al. 2021

BMJ Open Diab Res Care

View full text Add to dashboard Cite

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“…These results are consistent with those of previous studies. A retrospective cohort study of the association between pre‐infection glycemic control and disease severity in patients with type 2 diabetes and COVID‐19 in Israel found a gradual dose–response relationship between HbA1c level and the risk of severe COVID‐19 10 . A population‐based cohort study in England also suggested a higher risk of mortality from COVID‐19 in patients with either type 1 or type 2 diabetes with HbA1c levels >10.0% than in those with HbA1c levels of less than 6.5% 19 .…”

Section: Discussionmentioning

confidence: 99%

HbA1c measurement may save COVID‐19 inpatients from overlooked diabetes

Yoroidaka

Kurita

Kita

2022

J of Diabetes Invest

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Aims/Introduction To investigate overlooked diabetes in patients with coronavirus disease 2019 (COVID‐19). Materials and Methods In total, 462 COVID‐19 inpatients were included in this retrospective study. The presence of diabetes before COVID‐19 admission, and the HbA1c and blood glucose levels at admission were examined. Results Of the 462 patients, 116 had diabetes. Seventy‐six patients had been diagnosed with diabetes before COVID‐19 admission, and 40 patients were diagnosed for the first time. Of the patients with diabetes 72% required insulin. Patients with diabetes were significantly ( P < 0.05) older, more likely to be male, heavier, and showed a lower eGFR. Patients with overlooked diabetes showed a lower HbA1c (average 7.1% vs 7.5%), a lower casual blood glucose (average 157 vs 179 mg/dL), and they used less insulin per day during hospitalization (average 16.0 units vs 34.5 units) than patients with previously diagnosed diabetes. Patients with overlooked diabetes tended to have more severe COVID‐19 than those with pre‐diagnosed diabetes. Multivariable logistic regression analyses showed that the increased odds ratios (ORs) of aggravation in all patients with COVID‐19 were associated with age [OR 1.04], BMI [OR 1.05], and diabetes [OR 2.15]. The risk factors for aggravation in patients with COVID‐19 and diabetes were age [OR 1.05] and HbA1c [OR 1.45]. Conclusions Diabetes is a predictor of COVID‐19 aggravation. Furthermore, in COVID‐19 patients with diabetes, high HbA1c levels are a risk factor for severe COVID‐19. A total of 8.7% of COVID‐19 inpatients were diagnosed with diabetes after HbA1c was measured on admission. Therefore, it is important to measure HbA1c in COVID‐19 patients.

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“…1 Several epidemiological studies have pointed to diabetes as one of the major co-morbidities significantly associated with poor outcomes in COVID-19 patients. [2][3][4] COVID-19 involves a cytokine storm mediated by overproduction of pro-inflammatory cytokines, which is related to disease severity. 1 Type 2 diabetes (T2D) may worsen the COVID-19 prognosis as it causes a state of chronic inflammation; in particular, it is associated with high levels of tumour necrosis factor α (TNFα), which contributes to insulin resistance, and low levels of the anti-inflammatory cytokine interleukin (IL)-10.…”

Section: Introductionmentioning

confidence: 99%

“…Coronavirus disease 2019 (COVID‐19) disproportionately affects patients with co‐morbidities 1 . Several epidemiological studies have pointed to diabetes as one of the major co‐morbidities significantly associated with poor outcomes in COVID‐19 patients 2‐4 …”

Section: Introductionmentioning

confidence: 99%

Metformin use is associated with a decrease in the risk of hospitalization and mortality in COVID‐19 patients with diabetes: A population‐based study in Lombardy

Ojeda-Fernández

Foresta

Macaluso

et al. 2022

Diabetes Obesity Metabolism

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Aim: To compare the association of metformin use and coronavirus disease 2019 outcomes in a cohort of 31 966 patients with diabetes in Lombardy. Methods:We used a COVID-19 linkable administrative regional database to select patients with diabetes who were aged 40 years or older. They had at least two prescriptions of antidiabetic drugs in 2019 and a positive test for severe acute respiratory syndrome coronavirus-2 from 15 February 2020 to 15 March 2021. The association of metformin use and clinical outcomes was assessed by multivariable logistic regression analyses and after propensity score matching (PSM). Clinical outcomes were all-cause mortality, in-hospital mortality, hospitalization for COVID-19, and admission to an intensive care unit (ICU).Results: In multivariable models, metformin use was associated with a significantly lower risk of total mortality (OR 0.70; 95% CI 0.66-0.75), in-hospital mortality

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Preinfection glycaemic control and disease severity among patients with type 2 diabetes and COVID‐19: A retrospective, cohort study

Cited by 12 publications

References 20 publications

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

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

HbA1c measurement may save COVID‐19 inpatients from overlooked diabetes

Metformin use is associated with a decrease in the risk of hospitalization and mortality in COVID‐19 patients with diabetes: A population‐based study in Lombardy

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