Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID-19.

Abstract

Background Identification of risk factors of severe coronavirus disease 2019 (COVID‐19) is critical for improving therapies and understanding severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pathogenesis. We analyzed 184 patients hospitalized for COVID‐19 in Livingston, New Jersey for clinical characteristics associated with severe disease. The majority of patients with COVID‐19 had diabetes mellitus (DM) (62.0%), Pre‐DM (23.9%) with elevated fasting blood glucose (FBG), or a body mass index >30 with normal hemoglobin A1c (HbA1C) (4.3%). SARS‐CoV‐2 infection was associated with new and persistent hyperglycemia in 29 patients, including several with normal HbA1C levels. Forty‐four patients required intubation, which occurred significantly more often in patients with DM as compared with non‐diabetics. Severe COVID‐19 occurs in the presence of impaired glucose metabolism in patients, including those with DM, preDM, and obesity. COVID‐19 is associated with elevated FBG and several patients presented with new onset DM or in DKA. The association of dysregulated glucose metabolism and severe COVID‐19 suggests that SARS‐CoV‐2 pathogenesis involves a novel interplay with glucose metabolism. Exploration of pathways by which SARS‐CoV‐2 interacts glucose metabolism is critical for understanding disease pathogenesis and developing therapies.