medwireNews: The latest research supports uncontrolled blood glucose as a risk factor for poor COVID-19 outcomes in patients without diabetes, and insulin use as a risk marker in those with diabetes.
In the first of the two studies, Yang Jin (Huazhong University of Science and Technology, Wuhan, China) and study co-authors found admission fasting blood glucose (FBG) levels of 7.0 mmol/L (126 mg/dL) or higher to be a risk factor for in-hospital complications and 28-day mortality.
In all, 29.1% of the 605 patients without known diabetes had FBG at or exceeding this level on admission to hospital with COVID-19. The in-hospital complication rate was 39.2% and the 28-day mortality rate was 18.8%. Admission FBG at or exceeding 7.0 mmol/L was present in 50.9% of patients with complications versus 9.2% of patients without, and 50.9% versus 24.0% of those who died.
On multivariate analysis, patients with FBG at or above the 7.0 mmol/L threshold were a significant 2.30-fold more likely to die compared with those whose admission levels were below 6.1 mmol/L (110 mg/dL). Patients with intermediate levels had a nonsignificant 1.71-fold increase in risk (p=0.0524).
The highest and intermediate FBG levels were also associated with significant 3.99- and 2.61-fold increases in the risk for in-hospital complications, report Jin et al in Diabetologia.
“Glycaemic testing and control should be recommended for all COVID-19 patients even if they do not have pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders,” they conclude.
The second study focused on patients with diabetes, and showed that those who needed insulin to control their blood glucose while in hospital with COVID-19 had particularly high rates of poor outcomes.
Jun Lin (Zhongnan Hospital of Wuhan University) and co-researchers assessed 84 patients with diabetes, and consistent with previous research found these patients to have significantly poorer outcomes than 500 who did not have diabetes, after accounting for other variables.
Twenty-nine of the diabetes patients required insulin during their hospital stay; these patients were significantly older than the 55 who did not need insulin treatment, and were more often critically ill at the point of admission (51.7 vs 3.6%), with significantly higher levels of C-reactive protein and D-dimer, and lower levels of lymphocytes.
More insulin-treated than non-insulin-treated patients were admitted to the intensive care unit (27.6 vs 1.8%) and more died (51.7 vs 3.6%), and insulin-treated patients also had significantly higher rates of respiratory failure, and acute cardiac and kidney injury.
“Diabetic patients should be intensely monitored during treatment, especially those who require insulin therapy,” concludes the team in The American Journal of Medicine.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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Diabetologia 2020; doi:10.1007/s00125-020-05209-1
Am J Med 2020; doi:10.1016/j.amjmed.2020.05.033