Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality

Abstract

Aim: To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID-19 patients with and without diabetes.

Materials and methods: Danish nationwide registries were used to study the association between HbA1c levels and 30-day risk of all-cause mortality and the composite of severe COVID-19 infection, intensive care unit (ICU) admission and all-cause mortality. The study population comprised patients hospitalized with COVID-19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow-up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty-day standardized absolute risks and standardized absolute risk differences are reported.

Results: We identified 3295 hospitalized COVID-19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference).

Conclusions: Patients with COVID-19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome.

Keywords: antidiabetic drug; cardiovascular disease; database research; glycaemic control; hypoglycaemia; population study.

FIGURE 1

Standardized 30‐day absolute risks and standardized 30‐day absolute risk differences for all‐cause mortality and a composite of severe COVID‐19 infection, admission to intensive care unit, or all‐cause mortality according to glycated haemoglobin (HbA1c) level among hospitalized COVID‐19 patients with diabetes. Standardized to age, sex, history of ischaemic heart disease, heart failure, atrial fibrillation, stroke, peripheral artery disease, hypertension, chronic obstructive pulmonary disease, cancer, chronic renal disease, and use of cholesterol‐lowering drugs, beta‐blockers, calcium channel blockers, renin‐angiotensin system inhibitors, aspirin, and anticoagulants. SAR, standardized absolute risk

FIGURE 2

Standardized 30‐day absolute risks and standardized 30‐day absolute risk differences for all‐cause mortality and a composite of severe COVID‐19 infection, admission to intensive care unit, or all‐cause mortality according to glycated haemoglobin (HbA1c) level among hospitalized COVID‐19 patients without diabetes. Standardized to age, sex, history of ischaemic heart disease, heart failure, atrial fibrillation, stroke, peripheral artery disease, hypertension, chronic obstructive pulmonary disease, cancer, chronic renal disease, and use of cholesterol‐lowering drugs, beta‐blockers, calcium channel blockers, renin‐angiotensin system inhibitors, aspirin, and anticoagulants. SAR, standardized absolute risk