The Impact of COVID-19 on Blood Glucose: A Systematic Review and Meta-Analysis

Together with the ongoing serious Covid-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in Covid-19 recovered patients. Colloquially known as “black fungus”, mucormycosis commonly causes necrosis in the head and neck region including the nose, paranasal sinuses, orbits, facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that diagnosis is often delayed, and that is progresses rapidly. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant which has spread rapidly throughout India. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA, and UK. We present the findings of a study conducted on post-COVID Mucormycosis patients and discusses the associated risk factors to raise awareness for OMFS colleagues.

show abstract

“…13 This could be one of the reasons why COVID-19 patients who do not have a history of diabetes have higher blood glucose levels. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge

Rao

Arakeri

Madikeri

et al. 2021

British Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

show abstract

“…Infection with coronaviridae may have repercussions in insulin secretion and glycemia [ 1 ]. Critically ill and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Critically ill patients may show stress hyperglycemia [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Glycemia, Beta-Cell Function and Sensitivity to Insulin in Mildly to Critically Ill Covid-19 Patients

Ilias¹,

Diamantopoulos

Pratikaki

et al. 2021

Medicina

View full text Add to dashboard Cite

Background and objectives: Critically and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes. With this study we aimed to assess glucose, glycemic gap (GlyG) and insulin secretion/sensitivity measures in patients with Covid-19. Materials and Methods: We studied, upon admission, 157 patients with Covid-19 (84: in wards and 73: in intensive care units; ICU); 135 had no history of diabetes. We measured blood glucose upon admission as well as glycated hemoglobin (A1c), plasma insulin and C-peptide. We calculated the GlyG and the Homeostasis Model Assessment 2 (HOMA2) estimates of steady state beta cell function (HOMA2%B) and insulin sensitivity (HOMA2%S). Statistical assessment was done with analysis or the Kruskal-Wallis test. Results: Compared to patients in the wards without diabetes, patients with diabetes in the wards, as well as patients in the ICU (without or with diabetes) had higher admission glycemia. The GlyG was significantly higher in patients without diabetes in the ICU compared to patients without diabetes in the wards, while HOMA2%B based on glucose and insulin was significantly higher in the ICU patients compared to patients in the wards. Of all the parameters, HOMA2%S based on C-peptide/glucose was higher in survivors (n = 133). Conclusions: In our series of patients with Covid-19, a substantial number of patients with and without diabetes had admission hyperglycemia and those who were critically ill may have had compromised insulin secretion and lowered sensitivity to insulin. These findings lend credence to reports of association between Covid-19 and hyperglycemia/secondary diabetes.

show abstract

“… 14 , 15 A higher mortality rate in severe acute respiratory syndrome (SARS) was seen in diabetics and non-diabetics with above average increased fasting plasma glucose levels on admission, 16 although HbA1c itself was not examined. A meta-analysis that examined the severity of COVID-19 and glucose levels found higher blood glucose levels in patients with severe disease, 17 while a retrospective study of COVID-19 patients admitted to the ICU found an increased mortality rate amongst those with mean serum glucose levels >140 mg/dl versus those <140 mg/dl. 18 It is possible that the presence of diabetes is, in part, representative of poor overall health and that our findings of HbA1c and intubation or death may be a marker for patients who do not receive regular, preventive care.…”

Section: Discussionmentioning

confidence: 99%

Elevated glycohemoglobin is linked to critical illness in COVID-19: a retrospective analysis

Windham

Wilson

Fling

et al. 2021

Therapeutic Advances in Infection

View full text Add to dashboard Cite

Background: Several studies have explored hospitalization risk factors with the novel coronavirus disease 2019 (COVID-19) infection. Our goal was to identify clinical characteristics outside of laboratory or radiologic data associated with intubation or death within 7 days of admission. Methods: The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed COVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction. Results: Participants had a mean [standard deviation (SD)] age 55 (17), BMI 30.9 (8.2), 55% were male and 80% were ethnic/racial minorities. Increasing age [aOR: 1.24 (1.07, 1.45) per 10 years], higher BMI (aOR 1.03 (1.00, 1.06), and poorly controlled diabetes [hemoglobin A1C (HbA1c) ⩾ 8] (aOR 2.26 (1.24, 4.12) were significantly ( p < 0.05) associated with greater odds of intubation or death. Female sex [aOR: 0.63, 95% CI (0.40, 0.98); p value = 0.043] was associated with lesser odds of intubation or death. The odds of death and/or intubation increased 19% for every 1 unit increase in HbA1c value [OR: 1.19 (1.01, 1.43); p = 0.04]. Our final MCP model included indicators of A1C ⩾ 8, age > 65, sex, and minority status, but predicted intubation/death only slightly better than random chance [area under the receiver operating characteristic curve (AUC) = 0.61 (0.56, 0.67)]. Conclusion: In a hospitalized patient cohort with COVID-19, worsening control of diabetes as evidenced by higher HbA1c was associated with increased risk of intubation or death within 7 days of admission. These results complement and help clarify previous associations found between diabetes and acute disease in COVID-19. Importantly, our analysis is missing some known predictors of severity in COVID-19. Our predictive model had limited success, suggesting unmeasured factors contribute to disease severity differences.

show abstract

The Impact of COVID-19 on Blood Glucose: A Systematic Review and Meta-Analysis

Cited by 101 publications

References 34 publications

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge

Glycemia, Beta-Cell Function and Sensitivity to Insulin in Mildly to Critically Ill Covid-19 Patients

Elevated glycohemoglobin is linked to critical illness in COVID-19: a retrospective analysis

Contact Info

Product

Resources

About