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Published in: Endocrine 2/2022

21-05-2022 | COVID-19 | Original Article

Association between glycemic control and the outcome in hospitalized patients with COVID-19

Authors: Jamil Muqtadir Bhatti, Syed Ali Raza, Muhammad Owais Shahid, Ayesha Akhtar, Tauseef Ahmed, Bhagwan Das

Published in: Endocrine | Issue 2/2022

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Abstract

Purpose

Coronavirus disease 2019 (COVID-19) clinical outcome and disease severity affected by several factors; deterioration of glycemic control is one of them. Therefore, achieving optimum blood glucose parameters is hypothesized for better consequences of COVID-19. However, varying data supporting this hypothesis is available in literature. The intention of this study was to investigate the role of glycemic management on the prognosis of hospitalized COVID-19 patients with varying degrees of severity.

Methods

From April 2020 to January 2021, we carried this retrospective cohort in a clinical care facility in Pakistan.

Results

Mortality was lowest in patients with HbA1c of less than 7% (53 mmol/mol) (p < 0.001). Similarly, mortality was found lowest in patients with fasting blood glucose less than 126 mg/dl and random blood glucose less than 160 mg/dl (p < 0.001 in each). In contrast, need for admission in critical care was found highest in patients with HbA1c between 7 and 10% (53–86 mmol/mol) (p 0.002). However, participants with blood glucose levels during fasting greater than 200 mg/dl and random blood glucose levels greater than 250 mg/dl were found to have a greater need for invasive mechanical ventilation. Cox regression hazard showed no difference in risk of death and invasive mechanical ventilation based on previous glycemic control.

Conclusion

Effective diabetic management is correlated with a considerably lower risk of mortality and invasive mechanical ventilation in COVID-19 cases.
Literature
4.
go back to reference W.-J. Guan, Z.-Y. Ni, Y. Hu, W.-H. Liang, C.-Q. Ou, J.-X. He et al. Clinical characteristics of Coronavirus disease 2019 in China. N. Engl. J. Med. 382(18), 1708–1720 (2020)CrossRef W.-J. Guan, Z.-Y. Ni, Y. Hu, W.-H. Liang, C.-Q. Ou, J.-X. He et al. Clinical characteristics of Coronavirus disease 2019 in China. N. Engl. J. Med. 382(18), 1708–1720 (2020)CrossRef
5.
go back to reference D. Wang, B. Hu, C. Hu, F. Zhu, X. Liu, J. Zhang et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected Pneumonia in Wuhan, China. JAMA. 323(11), 1061–1069 (2020)CrossRef D. Wang, B. Hu, C. Hu, F. Zhu, X. Liu, J. Zhang et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected Pneumonia in Wuhan, China. JAMA. 323(11), 1061–1069 (2020)CrossRef
6.
go back to reference F. Zhou, T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu et al. Clinical course and risk factors for mortality of adult in-patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 395(10229), 1054–1062 (2020)CrossRef F. Zhou, T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu et al. Clinical course and risk factors for mortality of adult in-patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 395(10229), 1054–1062 (2020)CrossRef
7.
go back to reference I. Hamming, W. Timens, M.L. Bulthuis, A.T. Lely, G. Navis, H. van Goor, Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. The first step in understanding SARS pathogenesis. J. Pathol. 203(2), 631–637 (2004)CrossRef I. Hamming, W. Timens, M.L. Bulthuis, A.T. Lely, G. Navis, H. van Goor, Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. The first step in understanding SARS pathogenesis. J. Pathol. 203(2), 631–637 (2004)CrossRef
8.
go back to reference J.K. Yang, S.S. Lin, X.J. Ji, L.M. Guo, Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 47(3), 193–199 (2010)CrossRef J.K. Yang, S.S. Lin, X.J. Ji, L.M. Guo, Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 47(3), 193–199 (2010)CrossRef
9.
go back to reference E. Maddaloni, R. Buzzetti, Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab. Res. Rev. 31, e33213321 (2020). E. Maddaloni, R. Buzzetti, Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab. Res. Rev. 31, e33213321 (2020).
10.
go back to reference B. Cariou, S. Hadjadj, M. Wargny, M. Pichelin, A. Al-Salameh, I. Allix et al. Phenotypic characteristics and prognosis of in-patients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 63(8), 1500–1515 (2020)CrossRef B. Cariou, S. Hadjadj, M. Wargny, M. Pichelin, A. Al-Salameh, I. Allix et al. Phenotypic characteristics and prognosis of in-patients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 63(8), 1500–1515 (2020)CrossRef
11.
go back to reference L. Nalysnyk, M. Hernandez-Medina, G. Krishnarajah, Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes. Metab. 12(4), 288–298 (2010)CrossRef L. Nalysnyk, M. Hernandez-Medina, G. Krishnarajah, Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes. Metab. 12(4), 288–298 (2010)CrossRef
12.
go back to reference W. Guo, M. Li, Y. Dong, H. Zhou, Z. Zhang, C. Tian et al. diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab. Res. Rev. 31, e3319 (2020). W. Guo, M. Li, Y. Dong, H. Zhou, Z. Zhang, C. Tian et al. diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab. Res. Rev. 31, e3319 (2020).
13.
go back to reference M.A. Hill, C. Mantzoros, J.R. Sowers, Commentary: COVID-19 in patients with diabetes. Metabolism. 107, 154217 (2020)CrossRef M.A. Hill, C. Mantzoros, J.R. Sowers, Commentary: COVID-19 in patients with diabetes. Metabolism. 107, 154217 (2020)CrossRef
14.
go back to reference N. Chen, M. Zhou, X. Dong, J. Qu, F. Gong, Y. Han et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 395(10223), 507–513 (2020)CrossRef N. Chen, M. Zhou, X. Dong, J. Qu, F. Gong, Y. Han et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 395(10223), 507–513 (2020)CrossRef
15.
go back to reference R. Zhang, X. Wang, L. Ni, X. Di, B. Ma, S. Niu et al. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci 250, 117583 (2020)CrossRef R. Zhang, X. Wang, L. Ni, X. Di, B. Ma, S. Niu et al. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci 250, 117583 (2020)CrossRef
16.
go back to reference E. Burgos-Morón, Z. Abad-Jiménez, A.M. Marañón, F. Iannantuoni, I. Escribano-López, S. López-Domènech et al. Relationship between oxidative stress, ER stress, and inflammation in type 2 diabetes: The Battle Continues. J. Clin. Med 8(9), 1385 (2019). CrossRef E. Burgos-Morón, Z. Abad-Jiménez, A.M. Marañón, F. Iannantuoni, I. Escribano-López, S. López-Domènech et al. Relationship between oxidative stress, ER stress, and inflammation in type 2 diabetes: The Battle Continues. J. Clin. Med 8(9), 1385 (2019). CrossRef
17.
go back to reference Z. Wang, Z. Du, F. Zhu, Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res. Clin. Pract. 164, 108214 (2020)CrossRef Z. Wang, Z. Du, F. Zhu, Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res. Clin. Pract. 164, 108214 (2020)CrossRef
18.
go back to reference L. Liu, W. Wei, K. Yang, S. Li, X. Yu, C. Dong et al. Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019. J. Diabetes Investig. 12(6), 1064–1073 (2021)CrossRef L. Liu, W. Wei, K. Yang, S. Li, X. Yu, C. Dong et al. Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019. J. Diabetes Investig. 12(6), 1064–1073 (2021)CrossRef
19.
go back to reference C. Sardu, N. D'Onofrio, M.L. Balestrieri, M. Barbieri, M.R. Rizzo, V. Messina et al. Outcomes in patients with hyperglycemia affected by covid-19: can we do more on glycemic control? Diabetes Care 43(7), 1408–1415 (2020). CrossRef C. Sardu, N. D'Onofrio, M.L. Balestrieri, M. Barbieri, M.R. Rizzo, V. Messina et al. Outcomes in patients with hyperglycemia affected by covid-19: can we do more on glycemic control? Diabetes Care 43(7), 1408–1415 (2020). CrossRef
20.
go back to reference R. Bhatti, A.H. Khamis, S. Khatib, S. Shiraz, G. Matfin, Clinical characteristics and outcomes of patients with diabetes admitted for COVID-19 treatment in Dubai: single-centre cross-sectional study. JMIR Public Health Surveill 6(4), e22471 (2020)CrossRef R. Bhatti, A.H. Khamis, S. Khatib, S. Shiraz, G. Matfin, Clinical characteristics and outcomes of patients with diabetes admitted for COVID-19 treatment in Dubai: single-centre cross-sectional study. JMIR Public Health Surveill 6(4), e22471 (2020)CrossRef
21.
go back to reference A.K. Singh, R. Singh, Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19? Diabetes Metab. Syndr. 14(5), 725–727 (2020)CrossRef A.K. Singh, R. Singh, Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19? Diabetes Metab. Syndr. 14(5), 725–727 (2020)CrossRef
22.
go back to reference B. Bode, V. Garrett, J. Messler, R. McFarland, J. Crowe, R. Booth et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J. Diabetes Sci. Technol. 14(4), 813–821 (2020)CrossRef B. Bode, V. Garrett, J. Messler, R. McFarland, J. Crowe, R. Booth et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J. Diabetes Sci. Technol. 14(4), 813–821 (2020)CrossRef
23.
go back to reference P.B. Mehta, M.A. Kohn, S.K. Koliwad, R.J. Rushakoff, Lack of association between either outpatient or in-patient glycemic control and COVID-19 illness severity or mortality in patients with diabetes. BMJ Open Diabetes Res. Care 9(1), e002203 (2021). CrossRef P.B. Mehta, M.A. Kohn, S.K. Koliwad, R.J. Rushakoff, Lack of association between either outpatient or in-patient glycemic control and COVID-19 illness severity or mortality in patients with diabetes. BMJ Open Diabetes Res. Care 9(1), e002203 (2021). CrossRef
24.
go back to reference S. Agarwal, C. Schechter, W. Southern, J.P. Crandall, Y. Tomer, Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care. 43(10), 2339–2344 (2020)CrossRef S. Agarwal, C. Schechter, W. Southern, J.P. Crandall, Y. Tomer, Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care. 43(10), 2339–2344 (2020)CrossRef
25.
go back to reference Y. Yan, Y. Yang, F. Wang, H. Ren, S. Zhang, X. Shi et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res. Care 8(1), e001343 (2020)CrossRef Y. Yan, Y. Yang, F. Wang, H. Ren, S. Zhang, X. Shi et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res. Care 8(1), e001343 (2020)CrossRef
26.
go back to reference S. Riahi, L.R.S. Sombra, K.B. Lo, S.R. Chacko, A.G.M. Neto, Z. Azmaiparashvili et al. Insulin Use, Diabetes Control, and Outcomes in Patients with COVID-19. Endocr Res. 46(2), 45–50 (2021)CrossRef S. Riahi, L.R.S. Sombra, K.B. Lo, S.R. Chacko, A.G.M. Neto, Z. Azmaiparashvili et al. Insulin Use, Diabetes Control, and Outcomes in Patients with COVID-19. Endocr Res. 46(2), 45–50 (2021)CrossRef
27.
go back to reference L. Roncon, M. Zuin, G. Rigatelli, G. Zuliani, Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J. Clin. Virol. 127, 104354 (2020)CrossRef L. Roncon, M. Zuin, G. Rigatelli, G. Zuliani, Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J. Clin. Virol. 127, 104354 (2020)CrossRef
28.
go back to reference J. Cao, X. Hu, W. Cheng, L. Yu, W.J. Tu, Q. Liu, Clinical features and short-term outcomes of 18 patients with coronavirus disease 2019 in intensive care unit. Intensive Care Med. 46(5), 851–853 (2020)CrossRef J. Cao, X. Hu, W. Cheng, L. Yu, W.J. Tu, Q. Liu, Clinical features and short-term outcomes of 18 patients with coronavirus disease 2019 in intensive care unit. Intensive Care Med. 46(5), 851–853 (2020)CrossRef
29.
go back to reference C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 395(10223), 497–506 (2020)CrossRef C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 395(10223), 497–506 (2020)CrossRef
30.
go back to reference G.P. Fadini, M.L. Morieri, F. Boscari, P. Fioretto, A. Maran, L. Busetto et al. newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res. Clin. Pract. 168, 108374 (2020)CrossRef G.P. Fadini, M.L. Morieri, F. Boscari, P. Fioretto, A. Maran, L. Busetto et al. newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res. Clin. Pract. 168, 108374 (2020)CrossRef
31.
go back to reference M. Vamvini, V.A. Lioutas, R.J.W. Middelbeek, Characteristics and diabetes control in adults with type 1 diabetes admitted with COVID-19 infection. Diabetes Care 43(10), e120–e122 (2020)CrossRef M. Vamvini, V.A. Lioutas, R.J.W. Middelbeek, Characteristics and diabetes control in adults with type 1 diabetes admitted with COVID-19 infection. Diabetes Care 43(10), e120–e122 (2020)CrossRef
32.
go back to reference B. Cariou, S. Hadjadj, M. Wargny, M. Pichelin, A. Al-Salameh, I. Allix et al. Phenotypic characteristics and prognosis of in-patients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 63(8), 1500–1515 (2020)CrossRef B. Cariou, S. Hadjadj, M. Wargny, M. Pichelin, A. Al-Salameh, I. Allix et al. Phenotypic characteristics and prognosis of in-patients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 63(8), 1500–1515 (2020)CrossRef
33.
go back to reference S. Windham, M.P. Wilson, C. Fling, D. Sheneman, T. Wand, L. Babcock et al. Elevated glycohemoglobin is linked to critical illness in CoVID-19: a retrospective analysis. Ther. Adv. Infect. Dis. 8, 20499361211027390 (2021)PubMedPubMedCentral S. Windham, M.P. Wilson, C. Fling, D. Sheneman, T. Wand, L. Babcock et al. Elevated glycohemoglobin is linked to critical illness in CoVID-19: a retrospective analysis. Ther. Adv. Infect. Dis. 8, 20499361211027390 (2021)PubMedPubMedCentral
34.
go back to reference L. Zhu, Z.-G. She, X. Cheng, J.-J. Qin, X.-J. Zhang, J. Cai et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 31(6), 1068–77.e3 (2020)CrossRef L. Zhu, Z.-G. She, X. Cheng, J.-J. Qin, X.-J. Zhang, J. Cai et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 31(6), 1068–77.e3 (2020)CrossRef
35.
go back to reference Y. Zhang, H. Li, J. Zhang, Y. Cao, X. Zhao, N. Yu et al. The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single-centre, retrospective, observational study in Wuhan. Diabetes Obes. Metab. 22(8), 1443–1454 (2020)CrossRef Y. Zhang, H. Li, J. Zhang, Y. Cao, X. Zhao, N. Yu et al. The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single-centre, retrospective, observational study in Wuhan. Diabetes Obes. Metab. 22(8), 1443–1454 (2020)CrossRef
36.
go back to reference A. Coppelli, R. Giannarelli, M. Aragona, G. Penno, M. Falcone, G. Tiseo et al. Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study. Diabetes Care 43(10), 2345–2348 (2020)CrossRef A. Coppelli, R. Giannarelli, M. Aragona, G. Penno, M. Falcone, G. Tiseo et al. Hyperglycemia at Hospital Admission Is Associated With Severity of the Prognosis in Patients Hospitalized for COVID-19: The Pisa COVID-19 Study. Diabetes Care 43(10), 2345–2348 (2020)CrossRef
37.
go back to reference S. Wang, P. Ma, S. Zhang, S. Song, Z. Wang, Y. Ma et al. Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia. 63(10), 2102–2111 (2020)CrossRef S. Wang, P. Ma, S. Zhang, S. Song, Z. Wang, Y. Ma et al. Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes: a multi-centre retrospective study. Diabetologia. 63(10), 2102–2111 (2020)CrossRef
38.
go back to reference J. Zhang, W. Kong, P. Xia, Y. Xu, L. Li, Q. Li et al. Impaired fasting glucose and diabetes are related to higher risks of complications and mortality among patients with Coronavirus disease 2019. Front Endocrinol (Lausanne). 11, 525 (2020)CrossRef J. Zhang, W. Kong, P. Xia, Y. Xu, L. Li, Q. Li et al. Impaired fasting glucose and diabetes are related to higher risks of complications and mortality among patients with Coronavirus disease 2019. Front Endocrinol (Lausanne). 11, 525 (2020)CrossRef
39.
go back to reference A.R. Saand, M. Flores, T. Kewan, S. Alqaisi, M. Alwakeel, L. Griffiths et al. Does in-patient hyperglycemia predict a worse outcome in COVID-19 intensive care unit patients? J. Diabetes 13(3), 253–260 (2021)CrossRef A.R. Saand, M. Flores, T. Kewan, S. Alqaisi, M. Alwakeel, L. Griffiths et al. Does in-patient hyperglycemia predict a worse outcome in COVID-19 intensive care unit patients? J. Diabetes 13(3), 253–260 (2021)CrossRef
Metadata
Title
Association between glycemic control and the outcome in hospitalized patients with COVID-19
Authors
Jamil Muqtadir Bhatti
Syed Ali Raza
Muhammad Owais Shahid
Ayesha Akhtar
Tauseef Ahmed
Bhagwan Das
Publication date
21-05-2022
Publisher
Springer US
Keywords
COVID-19
Diabetes
Published in
Endocrine / Issue 2/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-022-03078-9

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