Association between Hyperglycemia at Hospital Presentation and Hospital Outcomes in COVID-19 Patients with and without Type 2 Diabetes: A Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients.

Nipith Charoenngam,Michael F Holick,Caroline M Apovian,Sara M Alexanian

doi:10.3390/nu13072199

Abstract

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel strain of coronavirus that causes the coronavirus disease (COVID-19)
We aimed to investigate whether the presence of type 2 diabetes (T2D) among patients with hyperglycemia was associated with these outcomes after controlling for blood glucose levels (BG) on admission, along with other potential confounding variables
Effect estimates were adjusted for age; sex; body mass index; smoking; alcohol drinking; and underlying comorbidities, including T2D, hypertension, dyslipidemia, coronary heart disease, cerebrovascular disease, COPD, asthma, malignancy, HIV infection, and heart failure. In this retrospective cohort study, we observed that hospitalized COVID-19 patients without T2D who had hyperglycemia defined by BG > 200 mg/dL upon hospital admission had significantly higher odds of in-hospital mortality and morbidity compared with patients without T2D who did not have hyperglycemia

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel strain of coronavirus that causes the coronavirus disease (COVID-19). Recent evidence has highlighted that the severe systemic inflammation seen in COVID-19 patients causes stress-induced hyperglycemia, and that SARS-CoV-2 can directly infect the pancreatic β-cells, resulting in β-cell dysfunction and insulin deficiency [9,10]. This suggests that the association between hyperglycemia and COVID-19 severity could be bidirectional

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