Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;43(12):3113-3116.
doi: 10.2337/dc20-1941. Epub 2020 Oct 13.

Fasting Blood Glucose and COVID-19 Severity: Nonlinearity Matters

Barrak Alahmad  1 , Abdullah A Al-Shammari  2   3 , Abdullah Bennakhi  2 , Fahd Al-Mulla  2 , Hamad Ali  4   5
Affiliations

Fasting Blood Glucose and COVID-19 Severity: Nonlinearity Matters

Barrak Alahmad et al. Diabetes Care. 2020 Dec.

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.

PubMed Disclaimer

Figures

Figure 1
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.
See this image and copyright information in PMC

References

    1. Benfield T, Jensen JS, Nordestgaard BG. Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. Diabetologia 2007;50:549–554 - PubMed
    1. Suaya JA, Eisenberg DF, Fang C, Miller LG. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S. PLoS One 2013;8:e60057. - PMC - PubMed
    1. Leibovici L, Yehezkelli Y, Porter A, Regev A, Krauze I, Harell D. Influence of diabetes mellitus and glycaemic control on the characteristics and outcome of common infections. Diabet Med 1996;13:457–463 - PubMed
    1. Wang S, Ma P, Zhang S, 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 2020;63:2102–2111 - PMC - PubMed
    1. Kondapally Seshasai SR, Kaptoge S, Thompson A, et al. .; Emerging Risk Factors Collaboration . Diabetes mellitus, fasting glucose, and risk of cause-specific death [published correction appears in N Engl J Med 2011;364:1281] N Engl J Med 2011;364:829–841 - PMC - PubMed