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
. 2021 Feb;9(1):e002026.
doi: 10.1136/bmjdrc-2020-002026.

Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection

Arsenio Vargas-Vázquez  1   2 , Omar Yaxmehen Bello-Chavolla  3 , Edgar Ortiz-Brizuela  4 , Alejandro Campos-Muñoz  1 , Roopa Mehta  1   5 , Marco Villanueva-Reza  4 , Jessica Paola Bahena-López  2 , Neftali Eduardo Antonio-Villa  1   2   3 , María Fernanda González-Lara  4 , Alfredo Ponce de León  4 , Jose Sifuentes-Osornio  6 , Carlos Alberto Aguilar-Salinas  7   5
Affiliations

Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection

Arsenio Vargas-Vázquez et al. BMJ Open Diabetes Res Care. 2021 Feb.

Abstract

Introduction: Diabetes and hyperglycemia are risk factors for critical COVID-19 outcomes; however, the impact of pre-diabetes and previously unidentified cases of diabetes remains undefined. Here, we profiled hospitalized patients with undiagnosed type 2 diabetes and pre-diabetes to evaluate its impact on adverse COVID-19 outcomes. We also explored the role of de novo and intrahospital hyperglycemia in mediating critical COVID-19 outcomes.

Research design and methods: Prospective cohort of 317 hospitalized COVID-19 cases from a Mexico City reference center. Type 2 diabetes was defined as previous diagnosis or treatment with diabetes medication, undiagnosed diabetes and pre-diabetes using glycosylated hemoglobin (HbA1c) American Diabetes Association (ADA) criteria and de novo or intrahospital hyperglycemia as fasting plasma glucose (FPG) ≥140 mg/dL. Logistic and Cox proportional regression models were used to model risk for COVID-19 outcomes.

Results: Overall, 159 cases (50.2%) had type 2 diabetes and 125 had pre-diabetes (39.4%), while 31.4% of patients with type 2 diabetes were previously undiagnosed. Among 20.0% of pre-diabetes cases and 6.1% of normal-range HbA1c had de novo hyperglycemia. FPG was the better predictor for critical COVID-19 compared with HbA1c. Undiagnosed type 2 diabetes (OR: 5.76, 95% CI 1.46 to 27.11) and pre-diabetes (OR: 4.15, 95% CI 1.29 to 16.75) conferred increased risk of severe COVID-19. De novo/intrahospital hyperglycemia predicted critical COVID-19 outcomes independent of diabetes status.

Conclusions: Undiagnosed type 2 diabetes, pre-diabetes and de novo hyperglycemia are risk factors for critical COVID-19. HbA1c must be measured early to adequately assess individual risk considering the large rates of undiagnosed type 2 diabetes in Mexico.

Keywords: COVID-19; diabetes mellitus; hyperglycemia; prediabetic state; type 2.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Logistic regression (A) and Cox proportional regression (B) analysis to evaluated COVID-19 outcomes. BMI, body mass index; C-RP, C reactive protein; T2DM, type 2 diabetes mellitus.
Figure 2
Figure 2
Causal mediation mechanism proposing the role of elevated plasma glucose levels on mediating the effect of acute inflammation on adverse SARS-CoV-2 outcomes explores in causally ordered mediation analyses. CRP, C reactive protein.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, et al. Predicting mortality due to SARS-CoV-2: a mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab 2020;105:2752–61. 10.1210/clinem/dgaa346 - DOI - PMC - PubMed
    1. Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: a systematic review and meta-analysis. Int J Infect Dis 2020;99:47–56. 10.1016/j.ijid.2020.07.029 - DOI - PMC - PubMed
    1. Yang JK, Feng Y, Yuan MY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med 2006;23:623–8. 10.1111/j.1464-5491.2006.01861.x - DOI - PubMed
    1. Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract 2020;164:108214. 10.1016/j.diabres.2020.108214 - DOI - PMC - PubMed
    1. Kulcsar KA, Coleman CM, Beck SE, et al. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight 2019;4:e131774. 10.1172/jci.insight.131774 - DOI - PMC - PubMed

MeSH terms