key: cord-0724806-7c4a8q70
authors: Chung, Seung Min; Ahn, June Hong; Moon, Jun Sung
title: Response: The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study (Diabetes Metab J 2020;44:405–13)
date: 2020-08-21
journal: Diabetes Metab J
DOI: 10.4093/dmj.2020.0167
sha: 089bebbb841a747e40b433d7742a89ea4f8dbd63
doc_id: 724806
cord_uid: 7c4a8q70

nan

We appreciate Dr. Kim and Professor Kim for their interest and comments on our article entitled "The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study" published in Diabetes & Metabolism Journal [1] .

South Korea experienced a massive outbreak of coronavirus disease 2019 (COVID-19) in February 2020; 52% of all confirmed cases and 66% of deaths occurred in Daegu City [2] . According to the data published to date, COVID-19 fatalities were prevalent in patients with comorbid diabetes; however, whether diabetes is a risk factor for death remains unclear [3] [4] [5] . Diabetes was shown as an independent risk factor for severe and critical outcomes (composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality) in COVID-19 patients after adjusting for other risk factors.

Among patients with diabetes, old age significantly increased the risk of severe and critical outcomes; however, glycosylated hemoglobin (HbA1c) and serum glucose levels did not. Long-term glycemic control (HbA1c) has not been identified as a significant predictor of COVID-19 prognosis and death [6] ; however, well-controlled blood glucose (≤180 mg/ dL) during hospitalization resulted in a better outcome [7] . Regardless of HbA1c level, proper blood glucose control during hospitalization (140 to 180 mg/dL) might improve the prognosis of COVID-19 [8] .

Contrary to concerns, anti-hyperglycemic agents or reninangiotensin system (RAS) inhibitors did not significantly affect the severity of COVID-19. To date, whether RAS inhibitors affect the prognosis of COVID-19 is unclear, and dipeptidyl peptidase-4 inhibitors showed a neutral effect [6, 9] . In our opinion, the existing drugs should be continued for mild to moderate COVID-19 patients, and in severe patients, insulin is most suitable for glycemic control [10] .

Finally, we thank the editor-in-chief of the Diabetes & Metabolism Journal and all the readers who showed interest in our research.

No potential conflict of interest relevant to this article was reported.

The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study

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Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study

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Committee of Clinical Practice Guidelines, Korean Diabetes Association. 2019 Clinical practice guidelines for type 2 diabetes mellitus in Korea

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