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. 2023 Jul;36(4):579-585.
doi: 10.1016/j.aucc.2022.05.002. Epub 2022 May 23.

Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study

Mark P Plummer  1 , Louise Rait  2 , Mark E Finnis  2 , Craig J French  3 , Samantha Bates  4 , James Douglas  4 , Mansi Bhurani  5 , Tessa Broadley  6 , Tony Trapani  6 , Adam M Deane  7 , Andrew A Udy  8 , Aidan J C Burrell  8 ; SPRINT-SARI Australia Investigators
Collaborators, Affiliations

Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study

Mark P Plummer et al. Aust Crit Care. 2023 Jul.

Abstract

Background: Internationally, diabetes mellitus is recognised as a risk factor for severe COVID-19. The relationship between diabetes mellitus and severe COVID-19 has not been reported in the Australian population.

Objective: The objective of this study was to determine the prevalence of and outcomes for patients with diabetes admitted to Australian intensive care units (ICUs) with COVID-19.

Methods: This is a nested cohort study of four ICUs in Melbourne participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project. All adult patients admitted to the ICU with COVID-19 from 20 February 2020 to 27 February 2021 were included. Blood glucose and glycated haemoglobin (HbA1c) data were retrospectively collected. Diabetes was diagnosed from medical history or an HbA1c ≥6.5% (48 mmol/mol). Hospital mortality was assessed using logistic regression.

Results: There were 136 patients with median age 58 years [48-68] and median Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 14 [11-19]. Fifty-eight patients had diabetes (43%), 46 patients had stress-induced hyperglycaemia (34%), and 32 patients had normoglycaemia (23%). Patients with diabetes were older, were with higher APACHE II scores, had greater glycaemic variability than patients with normoglycaemia, and had longer hospital length of stay. Overall hospital mortality was 16% (22/136), including nine patients with diabetes, nine patients with stress-induced hyperglycaemia, and two patients with normoglycaemia.

Conclusion: Diabetes is prevalent in patients admitted to Australian ICUs with severe COVID-19, highlighting the need for prevention strategies in this vulnerable population.

Keywords: Australia; COVID-19; Diabetes; Stress hyperglycaemia.

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Figures

Figure 1
Figure 1
Glucose control by category of glycaemia. Light grey = minimum, medium grey = mean, black = maximum blood glucose values. Boxes are median and interquartile range (IQR), with whiskers at 1.5 times the interquartile range; outliers are omitted.
Figure 2
Figure 2
Adjusted probability of death in hospital by category of glycaemia over age, modelled at the median APACHE II score. Open circles = normoglycaemia, open diamonds = stress-induced hyperglycaemia, solid squares = diabetes mellitus, with error bars the 95% confidence interval for the predicted probability. APACHE: Acute Physiology and Chronic Health Evaluation II.
Figure 3
Figure 3
Cumulative incidence plots for ICU discharge, plotted by group and at the median values of age and APACHE II score. Normoglycaemia (short dash, uppermost curve), stress-induced hyperglycaemia (long dash, lowermost curve), and diabetes (solid line, middle curve). APACHE: Acute Physiology and Chronic Health Evaluation II; ICU: intensive care unit.
See this image and copyright information in PMC

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