key: cord-0808961-il1zh1bo
authors: Ling, Ping; Luo, Sihui; Zheng, Xueying; Cai, Guoqi; Weng, Jianping
title: Elevated fasting blood glucose within the first week of hospitalization was associated with progression to severe illness of COVID‐19 in patients with preexisting diabetes: A multicenter observational study
date: 2020-10-30
journal: J Diabetes
DOI: 10.1111/1753-0407.13121
sha: 385e75984ca8825db065d18df82eb9d028ccc8d4
doc_id: 808961
cord_uid: il1zh1bo

Highlights: Fasting blood glucose < 10 mmol/L was proposed as a target of glycemic control during the first week of hospitalization in patients with preexisting diabetes. Poor HbA1c levels prior to coronavirus disease 2019 (COVID‐19) might not be associated with severity among patients with preexisting diabetes. Mean blood glucose seemed not to be associated with poor prognosis of COVID‐19. [Image: see text]Dynamics of fasting blood glucose, mean 2‐hour postprandial blood glucose of coronavirus disease 2019 (COVID‐19) patients with preexisting diabetes. This figure depicts the average values of (A) fasting blood glucose, (B) daily mean 2‐hour postprandial blood glucose of COVID‐19 patients with preexisting diabetes. Red lines represent the patients with preexisting diabetes who progressed to severe illness during admission (n=23), and blue lines represent those with preexisting diabetes who stayed nonsevere (n=26)

• Fasting blood glucose < 10 mmol/L was proposed as a target of glycemic control during the first week of hospitalization in patients with preexisting diabetes.

• Poor HbA1c levels prior to coronavirus disease 2019 (COVID-19) might not be associated with severity among patients with preexisting diabetes.

• Mean blood glucose seemed not to be associated with poor prognosis of COVID-19.

To the Editor: Diabetes is one of the most common comorbidities in patients with coronavirus disease 2019 (COVID-19) and a established risk factor of poor prognosis and mortality. [1] [2] [3] [4] Clinical data has established the association between hyperglycemia and the poor prognosis of COVID-19 in patients with preexisting diabetes. 5, 6 However, data are still limited on the association of glycosylated hemoglobin (HbA1c) and the prognosis of COVID-19 and the optimal target of glycemic control, especially during the early stage of hospitalization.

Therefore, we conducted this study to investigate the association of HbA1c and the outcome of COVID-19 and determine the optimal glucose level during the early stage of their hospitalization among patients with preexisting diabetes, in a cohort of laboratory-confirmed COVID-19 patients in China.

This was a multicenter observational study from "Construction of a bio-information platform for novel coronavirus pneumonia (COVID-19) patients follow-up in Anhui" (ChiCTR2000030331). Data of hospitalized, Ping Ling and Sihui Luo contributed equally to this work. To investigate the potential contribution of blood glucose to the progression of COVID-19, we divided the patients with diabetes, who were all nonsevere upon admission, into the severe group or the nonsevere group according to their final diagnosis. Two patients in the nonsevere group were excluded from analysis because of the unavailability of blood glucose data during hospitalization. We found that upon admission, there was no significant difference in HbA1c (severe vs nonsevere, 7.90 ± 1.73% vs 8.01 ± 1.35%, P = 0.792), suggesting that glycemic control before infection might not be associated with progression to severe illness. Within 1 week of admission, patients who progressed to severe illness had higher FBG (11.37 ± 3.75 mmol/L vs 9.52 ± 3.25 mmol/ L, P = 0.001, Figure 1A ) and higher 2-hour PBG (17.16 ± 5.87 mmol/L vs 12.80 ± 4.06 mmol/L, P = 0.002, Figure 1B ) compared with patients in the nonsevere group.

Based on these findings, we established RR regression models and found that only mean FBG over the first week of admission ≥10 mmol/L was significantly associated with a higher risk of progression to severe illness The data in this section represented the highest severity level assessed of a patient during hospitalization.

(adjusted RR 2.09, 95% CI 1.05 to 4.14), adjusted for age, sex, smoking status, and blood pressure. 2-hour PBG and mean blood glucose during the first week of admission also did not demonstrate independent association with progression to severe illness at levels ≥7.8 mmol/L, ≥10.0 mmol/L or ≥ 13.4 mmol/L. There was no significant association between HbA1c and progression of COVID-19, adjusted for potential confounders.

In this study, we found that better FBG within the first week of admission was significantly associated with the reduced risk of progression to severe illness. Notably, we found that FBG≥10 mmol/L could serve as an upper limit of FBG control for COVID-19 patients with diabetes. That might be caused by inflammatory responses following the viral infection, which was also observed in previous studies. 5 Also, hyperglycemia during early admission may directly accelerate the damage or promotes the life cycle of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), so as to propel progression to severe illness. 8 But mean blood glucose seemed not to be associated with poor prognosis. A possible reason may be different food administering pattern between patients of different severity. Besides, HbA1c upon admission represents the glycemic status prior to SARS-CoV-2 infection. A previous report of 132 COVID-19 patients indicated that HbA1c was associated with systemic inflammation, hypercoagulability, and poor prognosis, but these results are not adjusted for known risk factors of age, sex, or body mass index. 9 But in a multicenter study in France, association between HbA1c and the outcome of tracheal intubation for mechanical ventilation and/or death within 7 days of admission was not observed among COVID-19 patients with diabetes. 10 In our study, we added the evidence that glycemic control prior to the infection was not associated with increased risk of progression of COVID-19.

Collectively, hyperglycemia prior to the infection of SARS-CoV-2 might not play a significant role, but special attention should be paid to diabetic patients with suboptimal glucose control (≤10.0 mmol/L) during the early stage of hospitalization, especially within the first week.

This study is funded by the Fundamental Research Funds for the Central Universities (Grant number. YD9110004001, YD9110002002, and YD9110002008).

ORCID Ping Ling https://orcid.org/0000-0002-9889-5812 Jianping Weng https://orcid.org/0000-0002-7889-1697 F I G U R E 1 Dynamics of fasting blood glucose, mean 2-hour postprandial blood glucose of coronavirus disease 2019 (COVID-19) patients with preexisting diabetes. This figure depicts the average values of (A) fasting blood glucose, (B) daily mean 2-hour postprandial blood glucose of COVID-19 patients with preexisting diabetes. Red lines represent the patients with preexisting diabetes who progressed to severe illness during admission (n=23), and blue lines represent those with preexisting diabetes who stayed nonsevere (n=26)

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Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia released by the National Health Commission of the People's Republic of China

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Elevated fasting blood glucose within the first week of hospitalization was associated with progression to severe illness of COVID-19 in patients with preexisting diabetes: A multicenter observational study