Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control?

Abstract

Objective: An important prognostic factor in any form of infection seems to be glucose control in patients with type 2 diabetes. There is no information about the effects of tight glycemic control on coronavirus disease 2019 (COVID-19) outcomes in patients with hyperglycemia. Therefore, we examined the effects of optimal glycemic control in patients with hyperglycemia affected by COVID-19.

Research design and methods: Fifty-nine patients with COVID-19 hospitalized with moderate disease were evaluated. On the basis of admission glycemia >7.77 mmol/L, patients were divided into hyperglycemic and normoglycemic groups. Interleukin 6 (IL-6) and D-dimer levels were evaluated at admission and weekly during hospitalization. The composite end point was severe disease, admission to an intensive care unit, use of mechanical ventilation, or death.

Results: Thirty-four (57.6%) patients were normoglycemic and 25 (42.4%) were hyperglycemic. In the hyperglycemic group, 7 (28%) and 18 (72%) patients were diagnosed with diabetes already before admission, and 10 (40%) and 15 (60%) were treated without and with insulin infusion, respectively. The mean of glycemia during hospitalization was 10.65 ± 0.84 mmol/L in the no insulin infusion group and 7.69 ± 1.85 mmol/L in the insulin infusion group. At baseline, IL-6 and D-dimer levels were significantly higher in the hyperglycemic group than in the normoglycemic group (P < 0.001). Even though all patients were on standard treatment for COVID-19 infection, IL-6 and D-dimer levels persisted higher in patients with hyperglycemia during hospitalization. In a risk-adjusted Cox regression analysis, both patients with hyperglycemia and patients with diabetes had a higher risk of severe disease than those without diabetes and with normoglycemia. Cox regression analysis evidenced that patients with hyperglycemia treated with insulin infusion had a lower risk of severe disease than patients without insulin infusion.

Conclusions: Insulin infusion may be an effective method for achieving glycemic targets and improving outcomes in patients with COVID-19.

Figure 1

Flowchart of study population.

Figure 2

A: IL-6 levels at admission, 1 week, and 2 weeks and after hospitalization in patients with hyperglycemia and normoglycemia. B: D-dimer levels at admission, 1 week, and 2 weeks and after hospitalization in patients with hyperglycemia and normoglycemia. C: IL-6 levels at admission, 1 week, and 2 weeks and after hospitalization in patients with hyperglycemia treated with insulin infusion and those not treated with insulin infusion. D: D-dimer levels at admission, 1 week, and 2 weeks and after hospitalization in patients with hyperglycemia treated with insulin infusion and those not treated with insulin infusion. For panels A–D, box plots display the median, 25th and 75th percentiles, and range. E: Regression analysis between admission blood glucose levels and admission IL-6 levels. F: Regression analysis between admission blood glucose levels and admission D-dimer levels. *P < 0.05 vs. normoglycemia and vs. baseline values. §P < 0.05 vs. baseline.

Figure 3

A: Risk-adjusted Cox regression analysis curves showing survival from severe disease through 18 days for patients with COVID-19 stratified by hyperglycemia vs. normoglycemia. B: Risk-adjusted Cox regression analysis curves showing survival from severe disease through 18 days for patients with COVID-19 stratified by with diabetes vs. no diabetes. C: Risk-adjusted Cox regression analysis curves showing survival from severe disease through 18 days for patients with hyperglycemia and COVID-19 stratified by insulin infusion vs. no insulin infusion treatment. D: Kaplan-Meier analysis showing survival from severe disease through 18 days for patients with hyperglycemia and no diabetes, hyperglycemia and diabetes, no hyperglycemia but with diabetes, and no hyperglycemia and no diabetes. HR, hazard ratio.