Hyperglycaemia portends worse outcomes for hospitalized COVID-19 patients

Patients hospitalized with COVID-19 fare worse when they also have hyperglycaemia on admission, regardless of diabetes status — indicating that hyperglycaemia is a better predictor of severe outcomes from COVID-19 than diabetes, according to a study presented at the 2021 ENDO Meeting.

While having diabetes was associated with a longer duration of hospital stay than non-diabetes (13 vs 9.5 days; p<0.05), the rates of intubation, ICU admission, and death were higher in those presenting with hyperglycaemia, irrespective of whether they had diabetes. [ENDO 2021, abstract P22-16]

“Our results show hyperglycaemia portends worse outcomes in diabetics and non-diabetics with COVID-19,” said lead author Dr Samara Skwiersky from the State University of New York (SUNY) Downstate Medical Center in Brooklyn, New York, US. “The results from our study reiterate the importance of regularly monitoring blood glucose in patients hospitalized with COVID-19, even without a prior diagnosis of diabetes.”

Among patients with diabetes, individuals with >140 mg/dL glucose levels on admission were 2.4 times more likely to undergo intubation (95 percent confidence interval [CI], 1.2–4.5) or require ICU admission (95 percent CI, 1.3–4.6) than those with glucose levels of <140 mg/dL.

Similar findings were seen in patients without diabetes, whereby the rates of intubation and ICU admission were 2.3 folds and 3.5 folds higher, respectively, in those with admission glucose >140 vs <140 mg/dL. The risk of acute kidney injury was also 2.3 folds higher in those whose admission glucose exceeded 140 mg/dL than those below.

When stratified by an even higher glucose level of 180 mg/dL on admission, patients with glucose >180 mg/dL were fourfold more likely to die than those below this threshold (95 percent CI, 1.8–8.8) among nondiabetic patients, and 1.8 times more likely to die than those below the glucose threshold among diabetic patients.

In addition, an admission glucose of >180 mg/dL was also associated with a 2.7 times increased risk of intubation (95 percent CI, 1.3–5.6) and 2.9 times increased risk of ICU admission (95 percent CI, 1.3– 6.2).

“These findings suggest that patients presenting with hyperglycaemia require closer observation and more aggressive therapies,” said Skwiersky. “This [also] raises the testable hypothesis that intensive glucose control may improve outcomes in patients with COVID-19.”

“Whether hyperglycaemia is a marker or a cause of more severe COVID-19 is unknown,” she said.

The retrospective cohort study involved 708 patients (mean age 68, 51 percent male, 54 percent with diabetes) hospitalized with COVID-19 in a designated centre in Brooklyn, New York, US, during the first few months of the pandemic.

Although several previous studies have suggested hyperglycaemia as a risk factor severe COVID-19 illness, the current study is unique in that it included a predominantly African African population — which according to Skwiersky, represents a cohort disproportionately affected by COVID-19.

“More frequent glucose monitoring and treatment with insulin therapy to a target glucose value less than 140 mg/dL could improve outcomes in these patients,” Skwiersky suggested.