The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single‐centre, retrospective, observational study in Wuhan

Abstract

Aim: To explore whether coronavirus disease 2019 (COVID-19) patients with diabetes and secondary hyperglycaemia have different clinical characteristics and prognoses than those without significantly abnormal glucose metabolism. Materials and methods:We retrospectively analysed 166 COVID-19 patients at Tongji Hospital (Wuhan) from 8 February to 21 March 2020. Clinical characteristics and outcomes (as of 4 April 2020) were compared among control (group 1), secondary hyperglycaemia (group 2: no diabetes history, fasting plasma glucose levels of ≥7.0 mmol/L once and HbA1c values <6.5%) and patients with diabetes (group 3).Results: Compared with group 1, groups 2 and 3 had higher rates of leukocytosis, neutrophilia, lymphocytopenia, eosinopenia and levels of hypersensitive C-reactive protein, ferritin and d-dimer (P < .05 for all). Group 2 patients had higher levels of lactate dehydrogenase, prevalence of liver dysfunction and increased interleukin-8 (IL-8) than those in group 1, and a higher prevalence of increased IL-8 was found in group 2 than in group 3 (P < .05 for all). The proportions of critical patients in groups 2 and 3 were significantly higher compared with group 1 (38.1%, 32.8% vs. 9.5%, P < .05 for both). Groups 2 and 3 had significantly longer hospital stays than group 1, which was nearly 1 week longer. The composite outcomes risks were 5.47(1.56-19.82) and 2.61 (0.86-7.88) times greater in groups 2 and 3 than in group 1.Conclusions: Hyperglycaemia in both diabetes and secondary hyperglycaemia patients with COVID-19 may indicate poor prognoses. There were differences between patients with secondary hyperglycaemia and those with diabetes. We recommend that clinicians pay more attention to the blood glucose status of COVID-19 patients, even those not diagnosed with diabetes before admission.

Diabetes, obesity and COVID‐19: A complex interplay

“…Epidemiological studies must assess diabetes groups stratified with respect to ethnicity, diabetes complications and therapies to further understand susceptibility to primary infection and the risk of developing severe disease. Some striking findings have been noted in data already published; a strong association between diabetes and poor outcome has been noted in younger (aged <55 years) and less hypertensive individuals, 17 as well as those previously undiagnosed as having diabetes 44 . Given the latter finding, screening all admissions to hospital for hyperglycaemia and instituting early treatment where needed is important 45 …”

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.…”

“…9 At the same time, through oxidative stress generation, an acute increase in glycaemia may induce endothelial dysfunction and thrombosis, [8][9][10] which, in turn, may produce generalized organ damage, as described in COVID-19. 1 According to this view, it is evident that fast, tight control of hyperglycaemia during the early phase of COVID-19 might be…”

The Impact of COVID-19 on Blood Glucose: A Systematic Review and Meta-Analysis

“…Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe respiratory symptoms, and even death ( 1 ). According to recent researches, the overall mortality of COVID-19 ranged from 1.4 to 15% ( 2 – 4 ). Furthermore, an epidemiological study from Italy reported that the mortality of patients requiring intensive care unit admission was 26% ( 5 ).…”