Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19

Abstract

Background Diabetes is associated with poor coronavirus disease 2019 (COVID-19) outcomes. However, little is known on the impact of undiagnosed diabetes in the COVID-19 population. We investigated whether diabetes, particularly undiagnosed diabetes, was associated with an increased risk of death from COVID-19. Methods This retrospective study identified adult patients with COVID-19 admitted to Tongji Hospital (Wuhan) from January 28 to April 4, 2020. Diabetes was determined using patients’ past history (diagnosed) or was newly defined if the hemoglobin A1c (HbA1c) level at admission was ≥6.5% (48 mmol/mol) (undiagnosed). The in-hospital mortality rate and survival probability were compared between the non-diabetes and diabetes (overall, diagnosed, and undiagnosed diabetes) groups. Risk factors of mortality were explored using Cox regression analysis. Results Of 373 patients, 233 were included in the final analysis, among whom 80 (34.3%) had diabetes: 44 (55.0%) reported a diabetes history, and 36 (45.0%) were newly defined as having undiagnosed diabetes by HbA1c testing at admission. Compared with the non-diabetes group, the overall diabetes group had a significantly increased mortality rate (22.5% vs. 5.9%, p < 0.001). Moreover, the overall, diagnosed, and undiagnosed diabetes groups displayed lower survival probability in the Kaplan-Meier survival analysis (all p < 0.01). Using multivariate Cox regression, diabetes, age, quick sequential organ failure assessment score, and D-dimer ≥1.0 μg/mL were identified as independent risk factors for in-hospital death in patients with COVID-19. Conclusions The prevalence of undiagnosed pre-existing diabetes among patients with COVID-19 is high in China. Diabetes, even newly defined by HbA1c testing at admission, is associated with increased mortality in patients with COVID-19. Screening for undiagnosed diabetes by HbA1c measurement should be considered in adult Chinese inpatients with COVID-19.

Viral mapping in COVID-19 deceased in the Augsburg autopsy series of the first wave: A multiorgan and multimethodological approach

“…Diabetes in our cohort was present in 32% of the patients, which is in line with a large cohort of 5700 COVID-19 patients from the USA with 34% [55]. This comorbidity is associated with a higher mortality rate [56,57]. This fact was also proven in another meta-analysis performed by Huang and colleagues [53], which showed that diabetes is associated with severe COVID-19 and developing ARDS.…”

Chronic dysglycemia and risk of SARS‐CoV‐2 associated respiratory failure in hospitalized patients

“…Congruent with other recent studies, we found a high incidence of prediabetes (HbA1c 42–48 mmol/mol) or diabetes (HbA1c > 48 mmol/mol) in patients with severe Covid‐19. 12 , 13 , 14 In our study, prediabetes and undiagnosed diabetes as well as a poor glycemic control in patients with known diabetes mellitus constituted 74% of the patients with respiratory failure. In the same group of patients with respiratory failure, 62.5% of the patients were admitted to the ICU, of whom 61% were mechanically ventilated and 14% were supported with renal replacement therapy, indicating a severe course of the infection.…”

Diabetes, Metformin and the Clinical Course of Covid-19: Outcomes, Mechanisms and Suggestions on the Therapeutic Use of Metformin

“…Diabetes, among other comorbidities, increases the risk of a serious adverse prognosis for people who contract Covid-19, as shown by numerous individual studies, meta-analyses and systematic reviews ( Figure 1 ). ( Zhang et al, 2020a ; Ciceri et al, 2020 ; Yu et al, 2020 ; Zhou et al, 2020 ; Barron et al, 2020 ; Abu-Jamous et al, 2021 ; Lee et al, 2020 ; Wu J. et al, 2020 ; Fox et al, 2021 ; Chilimuri et al, 2020 ; Guan W. J. et al, 2020 ; Zhu et al, 2020 ; Yan et al, 2020 ; Petrilli et al, 2020 ; Al-Salameh et al, 2021 ; Shang et al, 2021 ; Xu et al, 2020 ; Kim et al, 2020 ; Liu et al, 2020 ; Docherty et al, 2020 ; Shi et al, 2020 ; Smith et al, 2020 ; Saha et al, 2021 ; Liu et al, 2021 ; Kaminska et al, 2021 ; Elezkurtaj et al, 2021 ; Corona et al, 2021 ; Sun et al, 2021 ; Bud et al, 2020 ; Palaiodimos et al, 2020 ; Miller et al, 2020 ; Varikasuvu et al, 2021 ; Hussain et al, 2020 ; Shang et al, 2020 ; Guo L. et al, 2020 ; Aggarwal et al, 2020 ; Zaki et al, 2020 ; Parveen et al, 2020 ; Wu et al, 2021 ; Mantovani et al, 2020 ; Huang I. et al, 2020 ; Kumar et al, 2020 ; Roncon et al, 2020 ) Populations of patents hospitalised or entering intensive care for Covid-19 include a relatively high prevalence of diabetes, typically 1.5-3 fold greater than similar populations without diabetes ( Carey et al, 2018 ; Abdi et al, 2020 ; Apicella et al, 2020 ; Bhatti et al, 2020 ; Wu C. et al, 2020 ; Hussain et al, 2020 ; Sathish and Cao, 2021 ;…”

“…Diabetes, among other comorbidities, increases the risk of a serious adverse prognosis for people who contract Covid-19, as shown by numerous individual studies, meta-analyses and systematic reviews (Figure 1). (Zhang et al, 2020a;Ciceri et al, 2020;Yu et al, 2020;Zhou et al, 2020;Barron et al, 2020;Abu-Jamous et al, 2021;Lee et al, 2020;Fox et al, 2021;Chilimuri et al, 2020;Guan W. J. et al, 2020;Zhu et al, 2020;Yan et al, 2020;Petrilli et al, 2020;Al-Salameh et al, 2021;Shang et al, 2021;Xu et al, 2020;Kim et al, 2020;Liu et al, 2020;Docherty et al, 2020;Shi et al, 2020;Smith et al, 2020;Saha et al, 2021;Liu et al, 2021;Kaminska et al, 2021;Elezkurtaj et al, 2021;Corona et al, 2021;Sun et al, 2021;Bud et al, 2020;Palaiodimos et al, 2020;Miller et al, 2020;Varikasuvu et al, 2021;Hussain et al, 2020;Shang et al, 2020;Guo L. et al, 2020;Aggarwal et al, 2020;Zaki et al, 2020;Parveen et al, 2020;Wu et al, 2021;Mantovani et al, 2020;…”