Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes

Mehta, Paras B; Kohn, Michael A.; Koliwad, Suneil K.; Rushakoff, Robert J

doi:10.1136/bmjdrc-2021-002203

Cited by 14 publications

(11 citation statements)

References 30 publications

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“…As noted by Kristan et al, acute glycemic control may prove to have better outcomes, rendering HbA1c values useless in predicting mortality rates [ 1 ]. Interestingly, other studies, including one by Mehta et al, found that there was no correlation between inpatient glycemic control and mortality rates [ 16 ]. Taking it a step further, Randhawa et al found that glycemic control may correlate strongly with severe complications in hospitalized COVID-19 patients but may not affect mortality specifically [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive glucose control was associated with shorter lengths of stay and overall decreased mortality rates as compared with poor glucose control [ 1 ]. On the other hand, a study conducted by Mehta et al in 2021 showed that outpatient glucose control, inpatient glucose control, average glucose during hospital admission, or even level of HbA1c did not correlate with ventilator requirement, ICU admission, or mortality in patients hospitalized with COVID-19 [ 16 ]. Thus, there have been variations in data reported regarding diabetes, its specific markers, and its association or lack thereof with the severity of COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

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Correlation Between HbA1c Levels and Mortality Rates in Hospitalized COVID-19 Patients

Bhagat¹,

Buxton²,

Hasan³

2022

Cureus

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Throughout the coronavirus disease 2019 (COVID-19) pandemic, multiple factors have been associated with poor prognosis for those infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Age, obesity, and medical comorbidities have been linked to poor outcomes, including admission to the intensive care unit (ICU), acute renal failure, stroke, myocardial infarction (MI), mechanical ventilation, and even death for hospitalized COVID-19 patients. Although diabetes mellitus (DM) has also been included in this set of medical comorbidities, there have been inconsistencies in the currently available body of literature, suggesting that mortality rates may or may not be correlated to elevated glycosylated hemoglobin (HbA1c) levels. This study aims to determine whether there is a correlation or trend between a range of HbA1c values and in-hospital mortality among patients admitted to the hospital with a COVID-19 diagnosis. Materials and methodsThis study was a retrospective review of electronic medical records at Arrowhead Regional Medical Center in Colton, CA. Any patient above the age of 18 admitted to the hospital during a predetermined time frame, with either a positive COVID-19 PCR test on admission or during their hospital stay, was included in the study. These medical charts were reviewed for HbA1c values during admission or within three months prior to admission. In-hospital mortality was then recorded for each medical record with an available HbA1c value. Hospital discharge summaries were used to delineate comorbidities, including chronic kidney disease, cerebrovascular disease, coronary artery disease, congestive heart failure, cancer history, or history of deep vein thrombosis/pulmonary embolism among the patients included in the study. Average HbA1c values were recorded for the mortality and non-mortality groups, and their statistical significance was calculated. ResultsIn this retrospective study, HbA1c levels were compared to mortality rates among adult patients admitted to the hospital with a concurrent COVID-19 diagnosis. From the analysis conducted, those with higher HbA1c levels did not have an increased rate of in-hospital mortality, and those with lower HbA1c levels did not have a decreased rate of in-hospital mortality. Comorbidity data as a confounding factor was also reviewed and excluded from the final analysis. The SARS-CoV-2 vaccine was also excluded as a confounder in this study by selecting a specific time frame for data collection. Based on our results, we propose that HbA1c levels likely have little to minimal correlation with mortality rates among hospitalized COVID-19 patients. ConclusionIn this study, we show that HbA1c levels, regardless of concurrent comorbidities, are unlikely to be correlated to mortality rates among hospitalized COVID-19 patients. HbA1c levels should not be used as a marker for whether these patients should be admitted to the hospital for further inpatient management or discharged from the emergency department.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Correlation Between HbA1c Levels and Mortality Rates in Hospitalized COVID-19 Patients

Bhagat¹,

Buxton²,

Hasan³

2022

Cureus

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“…With regard to random blood glucose (RBG), elevated values on admission were related to higher mortality, plasma levels of IL-6, and CRP ( 165 ), and increased severity of COVID-19 infection ( 166 ). According to other authors, however, RBG on admission was not significantly associated with disease prognosis ( 109 , 113 , 167 , 168 ).…”

Section: Stress Hyperglycemia Dm Hyperglycemia Newly Diagnosed Dm And...mentioning

confidence: 70%

The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course—A Narrative Review

Tzeravini¹,

Stratigakos²,

Siafarikas³

et al. 2022

Front. Clin. Diabetes Healthc.

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It was previously reported that subjects with diabetes mellitus (DM) are more vulnerable to several bacterial or viral infections. In the era of coronavirus disease 2019 (COVID-19) pandemic, it is reasonable to wonder whether DM is a risk factor for COVID-19 infection, too. It is not yet clear whether DM increases the risk for contracting COVID-19 infection or not. However, patients with DM when infected are more likely to develop severe or even fatal COVID-19 disease course than patients without DM. Certain characteristics of DM patients may also deteriorate prognosis. On the other hand, hyperglycemia per se is related to unfavorable outcomes, and the risk may be higher for COVID-19 subjects without pre-existing DM. In addition, individuals with DM may experience prolonged symptoms, need readmission, or develop complications such as mucormycosis long after recovery from COVID-19; close follow-up is hence necessary in some selected cases. We here present a narrative review of the literature in order to set light into the relationship between COVID-19 infection and DM/hyperglycemia.

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“…A similar lack of association of inpatient glycemic control, estimated via mean glucose per patient-day, on illness severity and mortality has been reported previously. 25 On the other hand, several previous studies 6 , 26 , 27 have demonstrated that hyperglycemia was associated with a higher risk of severe disease and death during COVID-19 admission. However, these studies had different estimations of hyperglycemia, such as by using the highest 2 h postprandial BG, 26 admission fasting BG 27 or the mean BG on days 2–3.…”

Section: Discussionmentioning

confidence: 95%

Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients With Diabetes Hospitalized With COVID-19

Milosavljevic¹,

Perkit²,

Jhawar³

et al. 2022

Journal of Community Hospital Internal Medicine Perspectives

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Objectives To identify risk factors for severe disease and death among patients with diabetes and coronavirus disease 2019 (COVID-19) infection. Methods This retrospective cohort study conducted at three hospitals included 733 consecutive patients with DM admitted with confirmed COVID-19 (March 1 – December 31, 2020). Multivariable logistic regression was performed to identify predictors of severe disease and death. Results The mean age was 67.4 ± 14.3 years, 46.9% were males and 61.5% were African American. Among all patients, 116 (15.8%) died in the hospital. A total of 317 (43.2%) patients developed severe disease, 183 (25%) were admitted to an ICU and 118 (16.1%) required invasive mechanical ventilation. Increasing BMI (OR, 1.13; 95% CI, 1.02–1.25), history of chronic lung disease (OR, 1.49; 95% CI, 1.05–2.10) and increasing time since the last HbA1c test (OR, 1.25; 95% CI, 1.05–1.49) were the preadmission factors associated with increased odds of severe disease. Preadmission use of metformin (OR, 0.67; 95% CI, 0.47–0.95) or GLP-1 agonists (OR, 0.49; 95% CI, 0.27–0.87) was associated with decreased odds of severe disease. Increasing age (OR, 1.21; 95% CI, 1.09–1.34), co-existing chronic kidney disease greater than stage 3 (OR, 3.38; 95% CI, 1.67–6.84), ICU admission (OR, 2.93; 95% CI, 1.28–6.69) and use of invasive mechanical ventilation (OR, 8.67, 95% CI, 3.88–19.39) were independently associated with greater odds of in-hospital death. Conclusion Several clinical characteristics were identified to be predictive of severe disease and in-hospital death among patients with underlying diabetes hospitalized with COVID-19.

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Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes

Cited by 14 publications

References 30 publications

Correlation Between HbA1c Levels and Mortality Rates in Hospitalized COVID-19 Patients

Correlation Between HbA1c Levels and Mortality Rates in Hospitalized COVID-19 Patients

The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course—A Narrative Review

Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients With Diabetes Hospitalized With COVID-19

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