Study backs in-hospital hyperglycemia as COVID-19 mortality risk factor
medwireNews: A second study, this time from China, has pinpointed poor blood glucose control in hospital as a potential risk factor for mortality among patients with COVID-19.
The previous, US study looked at the effect of in-hospital hyperglycemia on patients with and without diabetes, finding it to be associated with mortality risk in both groups in an unadjusted analysis.
This latest publication reports the effect of poor glucose control only in patients with pre-existing diabetes, but does so in a propensity-adjusted analysis accounting for variables that could confound the relationship between hyperglycemia and mortality risk. Patients who had diabetes were older than those who did not, at a median of 62 versus 53 years, had a higher BMI, and higher rates of comorbidities including coronary heart disease and renal disease.
While in hospital the people with diabetes required more intensive treatment, receiving medications including antibiotics, systemic corticosteroids, and antihypertensives more frequently than patients without, and they more often required oxygen and noninvasive and invasive ventilation. They were also more likely to experience complications such as acute respiratory distress syndrome (ARDS), acute heart or kidney injury, and septic shock.
During the 28 days after admission, 7.8% of patients with diabetes died, compared with 2.7% of those without diabetes, and this difference remained significant after accounting for age, sex, hospital site, and COVID-19 severity.
“We here did not adjust for comorbidities closely related to [type 2 diabetes], including hypertension, [coronary heart disease], cerebrovascular disease, and chronic kidney disease, as these diseases often co-exist with [type 2 diabetes],” say Hongliang Li (Renmin Hospital of Wuhan University, China) and co-researchers.
And they stress that “care must be taken in interpreting the significant difference in outcomes between diabetic and non-diabetic patients with COVID-19, since there were notable differences in the covariate distributions between the two groups.”
The total cohort comprised 7337 patients with COVID-19 aged between 18 and 75 years, of whom 952 (13.0%) had pre-existing type 2 diabetes. A total of 142 patients had hypoglycemia while in hospital, or no glucose available measurement.
From the remainder, the researchers identified 250 whose in-hospital blood glucose remained between 3.9 and 10.0 mmol/L (70–180 mg/dL) and matched them with 250 whose blood glucose exceeded the upper limit. Blood glucose was “much lower” in the former than latter group, they report, at a median of 6.4 versus 10.9 mmol/L (115 vs 196 mg/dL).
Patients with well-controlled blood glucose had an 86% reduction in 28-day mortality risk relative to those with poorly controlled glucose, despite the latter group receiving significantly more medications and other interventions. They also had a significantly reduced risk for ARDS, acute heart injury, and acute kidney injury.
Writing in Cell Metabolism, the researchers say their results support the recent expert recommendations on managing diabetes in patients with COVID-19.
“These findings provide critical insights into the clinical characteristics of patients with COVID-19 and pre-existing [type 2 diabetes] and the possible avenues to improving their disease outcomes,” conclude the researchers.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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