Glycemic fluctuations linked to poor COVID-19 outcomes
medwireNews: Elevated glucose levels and glycemic fluctuations during the first week of hospitalization for COVID-19 are associated with an increased risk for unfavorable outcomes, research suggests.
The study included 548 people with COVID-19 (median age 57 years, 54% women) who were admitted to the Central Hospital of Wuhan in China between January and February 2020, of whom 18% had diabetes. In all, 39% of the study population experienced acute respiratory distress syndrome (ARDS) and 11% died.
Liegang Liu (Huazhong University of Science and Technology, Wuhan) and colleagues report that individuals with higher peak and mean glucose levels, and those with a larger degree of fluctuation in glucose levels, in the week following hospital admission had a higher risk for subsequent ARDS and mortality, and “these associations seemed to occur in a dose-dependent manner.”
For instance, in a model adjusting for factors including age, sex, comorbidities, glucocorticoid use, and C-reactive protein levels, people with average glucose levels of 6.1–7.8 mmol/L (110.0–140.6 mg/dL) had a significant 2.8-fold higher mortality risk than those with average levels of 6.1 mmol/L or lower, rising to a sixfold increased risk for people with levels of 7.8–10.0 mmol/L (140.6–180.2 mg/dL) and a 12.2-fold increased risk for those with levels above 10.0 mmol/L.
Each standard deviation (SD) increase in log-transformed mean glucose levels was associated with a 2.4-fold increased mortality risk, while each SD increase in peak glucose levels was associated with a 1.9-fold increased risk.
Using the same model, Liu et al found an analogous pattern of results with increasing glycemic variability according to SD of week 1 glucose (GSD), calculated as the square root of the variance of daily fasting glucose levels. Compared with people who had a GSD of 0.4 mmol/L (7.3 mg/dL) or less, those with a GSD of 0.9–1.8 mmol/L (16.3–32.5 mg/dL) had a 1.9-fold increased mortality risk, while those with a GSD of more than 1.8 mmol/L had a 2.7-fold increased risk. Each SD increment of log-transformed GSD was associated with a significant 1.8-fold higher mortality risk.
Similarly, for ARDS, each SD increase in log-transformed mean and peak glucose levels was associated with a significant 1.5-fold elevated risk, while each SD increase in log-transformed GSD was associated with a 1.3-fold increase in risk.
Liu et al note that previous research has identified diabetes status and fasting glucose at the time of admission as factors associated with COVID-19 prognosis, whereas their study is the first to demonstrate an impact of glucose variability.
“These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization,” they conclude in Diabetes Care.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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