Hyperglycemia Better Predictor of Severe COVID-19 Than Diabetes

People with hyperglycemia fared far worse when hospitalized with COVID-19, researchers found.

Out of 708 predominantly Black patients at a single center in New York City, those who had hyperglycemia -- with or without a prior diagnosis of diabetes -- who were admitted with COVID-19 had higher mortality and intubation rates, Samara Skwiersky, MD, MPH, of SUNY Downstate Medical Center in Brooklyn, New York, reported at the Endocrine Society's virtual ENDO 2021 meeting.

And patients with a previous diagnosis of diabetes and an admission glucose over 140 mg/dL saw a 2.4 times higher odds of both intubation (OR 2.4, 95% CI 1.3-4.6) and intensive care unit (ICU) admission (OR 2.4, 95% CI 1.2-4.6).

But these patients with diabetes who had an even higher admission glucose (i.e., above 180 mg/dL) had a 1.8 times higher chance of mortality (OR 1.8, 95% CI 1.2-2.9), after adjustment for age, sex, white blood cell count, creatinine, hypertension, cardiovascular disease, chronic kidney disease, and body mass index (BMI).

On the other hand, patients not already diagnosed with diabetes upon admission and had a blood glucose over 140 mg/dL had some of the worst COVID-19 outcomes across the board, with significantly higher rates of mortality (OR 2.0, 95% CI 1.2-3.5), intubation (OR 2.3, 95% CI 1.3-4.2), ICU admission (OR 3.5, 95% CI 1.8-6.6), and acute kidney injury (OR 2.3, 95% CI 1.3-4.2).

And non-diabetic patients who were admitted with a blood glucose over 180 mg/dL saw the highest chance of COVID-related mortality, with a four times higher chance of death (OR 4.0, 95% CI 1.8-8.8). These patients also had a 2.7 and 2.9 times higher chance of intubation and ICU admission, respectively.

"Despite our results, it is still unclear whether hyperglycemic is the result of -- or cause -- of more severe COVID-19 illness," Skwiersky explained during a press conference.

"These results raise the testable hypothesis that intensive glucose control with more frequent monitoring and treatment with insulin to a target glucose of less than 140 could improve outcomes in patients hospitalized with COVID-19," she added.

The retrospective cohort study included patients admitted to SUNY Downstate Medical Center between March 1 and May 15, 2020 -- i.e., during the first few months of the COVID-19 pandemic.

"SUNY Downstate, which was designated as a COVID-only center by Governor [Andrew] Cuomo in the beginning of the pandemic, is located in East Flatbush, Brooklyn -- a neighborhood in which 89% of its population are non-Hispanic Black," Skwiersky explained.

A total of 383 patients were already diagnosed with diabetes prior to admission, defined as an HbA1c of 6.5% or higher in the previous 6 months. Among these patients, 71% had a blood glucose over 140 mg/dL upon admission and 57% had a reading above 180 mg/dL.

Another 325 patients who had not been diagnosed with diabetes were also included in the study, 32% of whom had a blood glucose above 140 mg/dL and 13%, above 180 mg/dL.

Out of the total cohort, the average age was 68, with a mean BMI of 29. The cohort was split about evenly between male and female, and 89% were non-Hispanic Black.

Upon admission, 82% of the total cohort had hypertension, 18% had chronic kidney disease, and 38% had obesity.

Skwiersky highlighted that one important aspect to note about the study is that the majority of the patient population did not have an available HbA1c reading within the 6 months prior to hospital admission, meaning that the "non-diabetes" population could actually include many latent or undiagnosed cases. This may be representative of underserved, minority communities, who lack access to regular healthcare and are already at a higher risk for more severe COVID-19 and related complications, she said.

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