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Multicenter Study
. 2020 Jun 2;31(6):1068-1077.e3.
doi: 10.1016/j.cmet.2020.04.021. Epub 2020 May 1.

Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Lihua Zhu  1 , Zhi-Gang She  1 , Xu Cheng  1 , Juan-Juan Qin  1 , Xiao-Jing Zhang  1 , Jingjing Cai  2 , Fang Lei  3 , Haitao Wang  4 , Jing Xie  5 , Wenxin Wang  1 , Haomiao Li  1 , Peng Zhang  6 , Xiaohui Song  3 , Xi Chen  4 , Mei Xiang  7 , Chaozheng Zhang  3 , Liangjie Bai  3 , Da Xiang  3 , Ming-Ming Chen  1 , Yanqiong Liu  3 , Youqin Yan  8 , Mingyu Liu  9 , Weiming Mao  10 , Jinjing Zou  11 , Liming Liu  12 , Guohua Chen  13 , Pengcheng Luo  14 , Bing Xiao  15 , Changjiang Zhang  16 , Zixiong Zhang  17 , Zhigang Lu  18 , Junhai Wang  19 , Haofeng Lu  20 , Xigang Xia  21 , Daihong Wang  22 , Xiaofeng Liao  23 , Gang Peng  24 , Ping Ye  7 , Jun Yang  25 , Yufeng Yuan  4 , Xiaodong Huang  26 , Jiao Guo  27 , Bing-Hong Zhang  28 , Hongliang Li  29
Affiliations
Multicenter Study

Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Lihua Zhu et al. Cell Metab. .

Abstract

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.

Keywords: COVID-19; SARS-CoV-2; blood glucose control; diabetes mellitus; mortality.

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Conflict of interest statement

Declaration of Interests The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Inclusion Criteria A schematic overview illustrating participant enrollment in the cohort study and the various exclusion and inclusion criteria among the initial case group. Briefly, a total of 9,663 patients with COVID-19 were included. After various exclusion criteria, 2,326 patients were removed from the study. Of the remaining 7,337 patients, data from 6,385 patients without diabetes (non-T2D) were placed in one group, while 952 individuals with type 2 diabetes (T2D) were placed in a second group. Of the 952 cases with T2D, 142 cases were further excluded due to hypoglycemia or lack of BG readings. Of the remaining 810 cases of T2D, 282 were considered to have well-controlled BG, while 528 had poorly controlled BG. And of these two T2D groups, 250 of each were used for propensity score-matched analysis.
Figure 2
Figure 2
Dynamics of BG, Lymphocytes, Neutrophils, IL-6, CRP, and LDH in Well-Controlled and Poorly Controlled BG Groups during Hospitalization Dynamic trajectories of blood glucose (A), lymphocytes (C), and neutrophils (E), and relative levels for IL-6 (B), CRP (D), and LDH (F) during the 28-day follow-up duration, with 95% confidence interval represented by shaded regions, in patients with poorly controlled BG (orange) or patients with well-controlled BG (blue). The BG represents the averaged median BG of patients on the day tested.
Figure 3
Figure 3
Survival Curves of Patients with Well-Controlled BG or Poorly Controlled BG in the PSM Model Kaplan-Meier Curves for cumulative probability of COVID-19 mortality during the 28-day follow-up duration in the well-controlled BG (blue) or poorly controlled BG (orange) cohort among 500 patients with T2D in the PSM model. The blips on the curve indicate censoring of cases during 28 days of follow-up.
See this image and copyright information in PMC

Comment in

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