Association between glycemic control and the outcome in hospitalized patients with COVID-19

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) clinical outcome and disease severity affected by several factors; deterioration of glycemic control is one of them. Therefore, achieving optimum blood glucose parameters is hypothesized for better consequences of COVID-19. However, varying data supporting this hypothesis is available in literature. The intention of this study was to investigate the role of glycemic management on the prognosis of hospitalized COVID-19 patients with varying degrees of severity.

Methods: From April 2020 to January 2021, we carried this retrospective cohort in a clinical care facility in Pakistan.

Results: Mortality was lowest in patients with HbA1c of less than 7% (53 mmol/mol) (p < 0.001). Similarly, mortality was found lowest in patients with fasting blood glucose less than 126 mg/dl and random blood glucose less than 160 mg/dl (p < 0.001 in each). In contrast, need for admission in critical care was found highest in patients with HbA1c between 7 and 10% (53-86 mmol/mol) (p 0.002). However, participants with blood glucose levels during fasting greater than 200 mg/dl and random blood glucose levels greater than 250 mg/dl were found to have a greater need for invasive mechanical ventilation. Cox regression hazard showed no difference in risk of death and invasive mechanical ventilation based on previous glycemic control.

Conclusion: Effective diabetic management is correlated with a considerably lower risk of mortality and invasive mechanical ventilation in COVID-19 cases.

Keywords: COVID-19; HbA1c; diabetes mellitus; intensive care unit; invasive mechanical ventilation; mortality.

Fig. 1

Flow chart

Fig. 2

Kaplan–Meier estimates of the cumulative probability of (A) Time from admission to discharge in days; (B) Time from admission to death in days; (C) Time from admission to intubation in days