Uncontrolled hyperglycemia might be COVID-19 mortality risk factor
medwireNews: A descriptive analysis of US patients with COVID-19 reports a high in-hospital mortality rate in those with uncontrolled hyperglycemia.
The rate was markedly higher than that seen in patients with confirmed diabetes, although Valerie Garrett (Glytec Inc., Waltham, Massachusetts, USA) and co-researchers note that they did not have information on comorbidities, including those believed to increase the risk for COVID-19 mortality.
The team drew data from the Glytec insulin titration software on 1122 patients hospitalized with COVID-19. They identified patients with diabetes, based on a glycated hemoglobin level of at least 6.5% (48 mmol/mol), and included patients with uncontrolled hyperglycemia, defined as at least two blood glucose measurements above 180 mg/dL (10 mmol/L) in a 24-hour period but with normal or untested glycated hemoglobin.
These criteria identified 194 (17.3%) patients with diabetes and 257 (22.9%) with uncontrolled hyperglycemia, although the study authors note that the uncontrolled hyperglycemia group likely included patients with diabetes who did not undergo a glycated hemoglobin test.
These two groups combined were older than patients who did not meet these criteria, had poorer kidney function, and were more frequently male.
A total of 552 patients remained in hospital at the time of the report. Of the others, 77 (13.5%) had died, with rates of 41.7% among those with uncontrolled hyperglycemia, 14.8% among those with diabetes, and 6.2% among other patients.
The average time in hospital prior to death was significantly longer for patients with uncontrolled hyperglycemia than those with diabetes, at 9.2 versus 7.2 days, and the average duration for those with neither was 7.9 days. Following a similar pattern, the corresponding average lengths of hospital stay for those discharged alive were 6.8 versus 5.8 days, and 5.0 days for patients with normal blood glucose.
Garrett and team note that patients with uncontrolled hyperglycemia had significantly lower admission blood glucose than those with diabetes, at 175.3 versus 238.3 mg/dL (9.7 vs 13.2 mmol/L). This “suggests an opportunity to manage uncontrolled hyperglycemia over the course of a hospitalization,” they say.
The team speculates that the constraints introduced by the need to minimize the risk of severe acute respiratory syndrome coronavirus-2 transmission might lead to reduced blood glucose testing and a tendency to avoid intravenous or basal–bolus insulin therapy.
“In our view, in the absence of evidence to the contrary, clinicians should interpret COVID-19 associated hyperglycemia as a potential indicator of pancreatic islet cell injury and a risk for poor outcome,” conclude the researchers.
“We recommend health systems ensure inpatient hyperglycemia is safely and effectively treated.”
The study is in press at the Journal of Diabetes Science and Technology.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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J Diabetes Sci Technol 2020; Not yet available online