Fasting Blood Glucose and COVID-19 Severity: Nonlinearity Matters

Abstract

Objective: Fasting blood glucose (FBG) could be an independent predictor for coronavirus disease 2019 (COVID-19) morbidity and mortality. However, when included as a predictor in a model, it is conventionally modeled linearly, dichotomously, or categorically. We comprehensively examined different ways of modeling FBG to assess the risk of being admitted to the intensive care unit (ICU).

Research design and methods: Utilizing COVID-19 data from Kuwait, we fitted conventional approaches to modeling FBG as well as a nonlinear estimation using penalized splines.

Results: For 417 patients, the conventional linear, dichotomous, and categorical approaches to modeling FBG missed key trends in the exposure-response relationship. A nonlinear estimation showed a steep slope until about 10 mmol/L before flattening.

Conclusions: Our results argue for strict glucose management on admission. Even a small incremental increase within the normal range of FBG was associated with a substantial increase in risk of ICU admission for COVID-19 patients.

Figure 1

Exposure-response relationship between FBG levels and the log odds of being admitted to the ICU. The crude relationship (top) and a fully adjusted model (bottom) are shown. The fully adjusted model is adjusted for age, sex, smoking, nationality, diabetes status, hypertension, asthma, cardiovascular disease, malignancy, and renal failure. Tick marks above the horizontal axis indicate individual cases.