By Denise Baez
Both hyperglycaemia and hypoglycaemia were associated with poor outcomes in patients with coronavirus disease 2019 (COVID-19), according to a study published in Diabetes Care.
An analysis of 1,544 patients with COVID-19 from 91 hospitals in 12 states — stratified according to achieved mean glucose category during hospitalisation — found that admission glucose was a strong predictor of death among the 360 patients directly admitted to the intensive care unit (ICU), and severe hyperglycaemia after admission was a strong predictor of death among the 1,184 patients admitted to a non-ICU setting.
Of the patients, 279 (18.1%) died in the hospital. The mortality for ICU patients (31%) was almost twice that in the non-ICU population (16%).
In non-ICU patients, severe hyperglycaemia (blood glucose >13.88 mmol/L [250 mg/dL]) on days 2 to 3 was independently associated with high mortality (adjusted hazard ratio [aHR] = 7.17; 95% confidence interval [CI], 2.62-19.62) compared with patients with blood glucose <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR = 1.465; 95% CI, 0.683-3.143).
In patients admitted directly to the ICU, severe hyperglycaemia on admission was associated with increased mortality (aHR = 3.14; 95% CI, 1.44-6.88). This relationship was not significant on day 2 (HR = 1.40; 95% CI, 0.53-3.69).
Hypoglycaemia (blood glucose <70 mg/dL) was also associated with increased mortality (odds ratio = 2.2; 95% CI, 1.35-3.60).
“The greater survival of the individuals with better control after admission compared with patients with uncontrolled glucose levels is clinically meaningful and indicates the need to start treatment of hyperglycaemia on admission,” wrote David C. Klonoff, MD, Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, and colleagues.
The authors noted that additional analyses are needed to determine the exact cause of hypoglycaemia (ie, insulin therapy or multi-organ failure).
Of the non-ICU patients, 40% had diabetes and average admission blood glucose level was 8.9 ± 4.4 mmol/L (159.5 ± 78.6 mg/dL). The incidence of adverse outcomes included transfer to the ICU (34%), hypoglycaemia (20%), acute kidney injury (21%), and mortality (16%). The median length of stay was 7.87 days before discharge or death, and the median time from admission to ICU transfer was 2.24 days for the 34% who transferred to the ICU.
Of the ICU patients, 40% had diabetes and the average blood glucose level was 10.1 ± 5.9 mmol/L (181.3 ± 105.6 mg/dL). The incidence of adverse outcomes included hypoglycaemia (20%), acute kidney injury (27%), and mortality (31%). The median length of stay was 9.06 days before discharge or death.