Background Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19). We conducted this study to determine if there is a correlation between hemoglobin A 1c (HbA 1c ) level and poor outcomes in hospitalized patients with diabetes and COVID-19. Methods This is a retrospective, single-center, observational study of patients with diabetes (as defined by an HbA 1c ≥ 6.5% or known medical history of diabetes) who had a confirmed case of COVID-19 and required hospitalization. All patients were admitted to our institution between March 3, 2020 and May 5, 2020. HbA 1c results for each patient were divided into quartiles; 5.1-6.7% (32-50 mmol/mol), 6.8-7.5% (51-58 mmol/mol), 7.6-8.9% (60-74 mmol/mol), and >9% (>75 mmol/mol). The primary outcome was in-hospital mortality. Secondary outcomes included admission to an intensive care unit, invasive mechanical ventilation, acute kidney injury, acute thrombosis, and length of hospital stay. Results Five hundred and six patients were included. The number of deaths within quartiles 1 through 4 were 30 (25%), 37 (27%), 34 (27%) and 24 (19%), respectively. There was no statistical difference in the primary or secondary outcomes between the quartiles except acute kidney injury was less frequent in quartile 4. Conclusions There is no significant association between HbA 1c level and adverse clinical outcomes in patients with diabetes who are hospitalized with COVID-19. HbA 1c should not be used for risk stratification in these patients.

OBJECTIVE: We report a case of thyrotoxic periodic paralysis (TPP) in a bodybuilder who developed paralysis secondary to thyrotoxicosis factitia (TF) after taking a supplement containing thyroid hormone. Interestingly, the patient had no intrinsic thyroid disease. Prompt recognition of thyrotoxicosis is critical to avoid progression of paralysis and subsequent complications. METHODS: We discuss a 27 year-old body builder who presented after a 3-day bodybuilding competition with sudden upper and lower extremity paralysis. He admitted to taking anabolic steroids, a supplement containing an unknown amount of thyroid hormone for two weeks, and furosemide 40 mg twice daily with near-complete fluid restriction for three days. RESULTS: Laboratory results showed a thyroid-stimulating hormone level of <0.010 mIU/L (0.3–5.8 uIU/mL), normal total T3 level, elevated free T4 level of 3.6 ng/dL (0.8–1.9 ng/mL), and potassium level of 1.9 mEq/L (3.7–5.2 mEq/L). Thyroid peroxidase antibody, thyroid stimulating immunoglobulin and thyroglobulin antibody levels were normal. Thyroid uptake was 1% (8–25%) after administration of I-123 and thyroglobulin level was 9 ng/mL (1.4 – 29.2 ng/mL). The patient was treated withnormal saline infusion, magnesium supplementation and a total of 230 mEq of potassium within 12 hours of hospitalization. Muscle weakness resolved within this time period and potassium level normalized. By the third day of hospitalization free thyroxine level also normalized and TSH improved to 0.1 mIU/L. CONCLUSION: TPP is a rare complication of thyrotoxicosis that should be considered in bodybuilders who are presenting with acute muscle weakness.