Dysglycaemia may increase likelihood of deterioration in non-severe COVID-19 patients

Patients with non-severe coronavirus disease 2019 (COVID-19) who have worse glycaemic status are more likely to deteriorate clinically, but glycaemic status does not adversely impact neutralizing antibody (NAb) responses, researchers from the University of Hong Kong have shown.

In a prospective study in 605 patients with predominantly non-severe COVID-19 (mean age, 50.2 years; male, 45.1 percent; non-severe COVID-19; 96.9 percent; symptomatic on presentation, 69.8 percent; median cycle threshold [Ct] value on admission, 24.62), clinical deterioration was significantly more likely in those with worse glycaemic status and higher HbA_1c (p<0.001). [Diabetes Res Clin Pract 2022;185:109232]

“[This was] likely secondary to the association of dysglycaemia with older age, symptomatic COVID-19, higher viral loads and levels of inflammation, which independently predicted clinical deterioration,” the researchers noted.

“Importantly, NAb responses did not differ across glycaemic status,” they highlighted.

On admission, patients with prediabetes (n=185) or diabetes (n=95) had more severe COVID-19 and higher C-reactive protein (CRP) levels than those with normoglycaemia (n=325) (p<0.001 for both). Initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was also higher in the diabetes group (Ct value: 21.30, 25.59 and 24.90 in those with diabetes, prediabetes and normoglycaemia, respectively; p=0.038).

“Of note, we observed an increasing trend of clinical deterioration among patients with progressively worse glycaemic status [p<0.001]. Specifically, the rate of clinical deterioration rose starting from prediabetes [p<0.05], mainly driven by new oxygen requirement,” the researchers reported.

While the risk of clinical deterioration was higher in patients with prediabetes (unadjusted odds ratio [OR], 3.43; 95 percent confidence interval [CI], 1.91 to 6.17; p<0.001) or diabetes (unadjusted OR, 4.07; 95 percent CI, 2.08 to 7.94; p<0.001) vs those with normoglycaemia, glycaemic status was not an independent predictor of clinical deterioration (p=0.067) after adjustment for age and comorbidities (hypertension, obesity, stroke or transient ischaemic attack).

Similarly, HbA_1c level was not an independent predictor of clinical deterioration, although higher levels were associated with higher odds of clinical deterioration (for each percent increase: unadjusted OR, 1.40; 95 percent CI, 1.16 to 1.70) (for each mmol/mol increase: unadjusted OR, 1.03; 95 percent CI, 1.01 to 1.05; p<0.001 for both).

“Independent determinants of clinical deterioration were age [adjusted OR, 1.04; 95 percent CI, 1.02 to 1.06; p<0.001], symptomatic presentation [adjusted OR, 3.06; 95 percent CI, 1.29 to 7.30], Ct value [adjusted OR, 0.10; 95 percent CI, 0.04 to 0.29; p<0.001], and CRP levels [adjusted OR, 2.11; 95 percent CI, 1.56 to 2.85; p<0.001],” the researchers wrote.

Among 314 patients who had NAb titres measured at any time point upon follow-up, most were NAb-positive throughout the 6-month follow-up period (1 month, 94.9 percent; 2 months, 93.8 percent; 3 months, 87.4 percent; 6 months, 80.3 percent).

“Glycaemic status was not an independent predictor of NAb responses at 1 month, and NAb responses to SARS-CoV-2 were not different across glycaemic status over 6 months of follow-up,” the researchers wrote.