Poor glycaemic control tied to COVID-19 progression

High concentrations of glycated haemoglobin (HbA1c) at hospital admission appears to increase the risk of COVID-19 progression to severe disease, a recent study has found.

The study included 415 COVID-19 patients with nonsevere disease, in whom HbA1c levels were measured using high-performance liquid chromatography. The outcome was disease progression to severe COVID-19, defined by the admission to the intensive care unit and the need for mechanical ventilation.

The median HbA1c at admission was 6.1 percent and a third (33.3 percent; n=138) of patients had diabetes. Most patients were admitted with mild COVID-19 (52.5 percent) and majority (77.6 percent; n=322) were eventually discharged.

Over the course of hospitalization, 118 patients developed hyperglycaemia, as defined by having plasma glucose levels ≥180 mg/dL. Progression to severe COVID-19 was reported in 22.4 percent (n=93) of patients. The median time from admission to progression was 4 days.

Cox modelling revealed that every 1-percent increase in HbA1c at admission led to a nearly 25-percent jump in the risk of COVID-19 progression to severe disease (hazard ratio [HR], 1.237, 95 percent confidence interval [CI], 1.037–1.475; p=0.018). Similarly, high HbA1c during admission was strongly associated with such progression (HR, 1.786, 95 percent CI, 1.079–2.956; p=0.024), more so than an elevated level of random plasma glucose or the presence of diabetes.

“It is suggested that poor glycaemic control before onset of the disease contributes to severe COVID-19 progression, thus management of glycaemic control before onset of COVID-19 is of critical importance for diabetes patients, as well as nondiabetic individuals,” the researchers said.