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Observational Study
. 2020 Jul;14(4):813-821.
doi: 10.1177/1932296820924469. Epub 2020 May 9.

Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Bruce Bode  1 , Valerie Garrett  2 , Jordan Messler  2 , Raymie McFarland  2 , Jennifer Crowe  2 , Robby Booth  2 , David C Klonoff  3
Affiliations
Observational Study

Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Bruce Bode et al. J Diabetes Sci Technol. 2020 Jul.

Erratum in

Abstract

Introduction: Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia.

Methods: This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec's data warehouse.

Results: Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001).

Conclusion: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.

Keywords: COVID-19; Glytec; diabetes; glucose; hospital; hyperglycemia; length of stay; mortality.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Bruce Bode is an advisory board member for Glytec and owns stock in Aseko/Glytec; his employer, Atlanta Diabetes Associates, receives grant support from DexCom, Insulet, Lilly, Medtronic, Novo Nordisk, and Sanofi. He is on the speaker bureau and consults with Lilly, Medtronic, Novo Nordisk, and Sanofi. Valerie Garrett, Jordan Messler, Raymie McFarland, Jennifer Crowe, and Robby Booth are employed by Glytec. David Klonoff is a consultant to Abbott, Ascensia, Dexcom, EOFlow, Fractyl, Lifecare, Novo, Roche, and Thirdwayv.

Figures

Figure 1.
Figure 1.
Study schematic of patient identification and classification.
Figure 2.
Figure 2.
U.S. States with COVID-19 study patients, March 1 to April 6, 2020.
Figure 3.
Figure 3.
Mortality rates among patients who were discharged or died comparing diabetes and/or uncontrolled hyperglycemia (n = 184) with patients without diabetes or hyperglycemia (n = 386).
Figure 4.
Figure 4.
Mortality rates among patients who were discharged or died comparing patients with diabetes (n = 88) with hyperglycemia patients (n = 96).
See this image and copyright information in PMC

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