Clinical outcomes of non-diabetic COVID-19 patients with different blood glucose levels: a nationwide Turkish study (TurCoGlycemia).

Cem Haymana,Tevfik Demir,Osman Celik,Mustafa Sahin,Erman Cakal,Rifat Emral,Ibrahim Sahin,Alper Sonmez,Ugur Unluturk,Derun Ertugrul,Aysegul Atmaca,Serpil Salman,Naim Ata,Ibrahim Demirci,Ilhan Satman,Murat Caglayan,Selcuk Dagdelen,Ilker Tasci

doi:10.1007/s12020-021-02789-9

Abstract

PurposeNew coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients.MethodsA nationwide retrospective cohort of non-diabetic patients with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were <100 mg/dL in group-1, in the range of 100–139 mg/dl in group-2, and the range of 140–199 mg/dl in group-3. Clinical characteristics and outcomes were compared among the groups. The primary outcome was mortality.ResultsA total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140–199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation.ConclusionHyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.

Highlights

New coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been one of the most important epidemics of the century threatening human health worldwide
We aimed to investigate the association of blood glucose levels by the time of COVID-19 diagnosis and clinical outcomes including hospitalization, mortality, and intensive care unit (ICU) admission and/or a need for mechanical ventilation in COVID-19 patients without diabetes mellitus
Chronic kidney disease was defined as a decreased estimated glomerular filtration rate based on the CKD-EPI equation [12]

Summary

Introduction

New coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been one of the most important epidemics of the century threatening human health worldwide. Mortality and morbidity rates of COVID-19 disease increase significantly in certain population groups such as males, older adults, or patients with comorbidities. Extended author information available on the last page of the article comorbidities in COVID-19 patients with considerably increased mortality and morbidity rates [3, 4]. Recent data indicate that new-onset hyperglycemia is common among hospitalized COVID-19 patients with no history of diabetes in the past. Hyperglycemia on hospital admission is a significant prognostic factor for COVID-19 patients without diabetes mellitus [5,6,7,8]. Studies from the United States, Italy, Spain, and China have consistently shown an increased risk of mortality, intensive care unit (ICU) admission, and a need for mechanical ventilation in patients with on admission hyperglycemia but no previous diagnosis of diabetes mellitus [5,6,7,8,9]

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