By Denise Baez
Fasting blood glucose at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes, according to a study published in Diabetologia.
It has been established that patients with COVID-19 who have diabetes and acute uncontrolled hyperglycaemia have higher rates of morbidity and mortality; however, this is the first study to show that elevated fasting blood glucose at admission in patients without a previous diagnosis of diabetes is associated with increased 28-day mortality and increased in-hospital complications.
The retrospective analysis, which included 605 patients, including 114 who died while hospitalised, found that fasting blood glucose ≥7.0 mmol/l independently predicted 28-day mortality (hazard ratio [HR] = 2.30; 95% confidence interval [CI], 1.49-3.55). Compared with patients with admission fasting blood glucose <6.1 mmol/l, patients with admission fasting blood glucose ≥7.0 mmol/l (odds ratio [OR] = 3.99 [95% CI 2.71, 5.88]) and 6.1–6.9 mmol/l (OR = 2.61 [95% CI 1.64, 4.41]) had higher levels of in-hospital complications.
Other factors associated with 28-day mortality included age (HR = 1.02; 95% CI, 1.00-1.04), male sex (HR = 1.75; 95% CI, 1.17-2.60), CRB-65 score of 1 to 2 (HR = 2.68; 95% CI, 1.56-4.59), and a CRB-65 score of 3 to 4 (HR = 5.25; 95% CI, 2.05-13.43).
“Glycaemic testing and control are important to all patients with COVID-19 even where they have no pre-existing diabetes, as most patients with COVID-19 are prone to glucose metabolic disorders,” reported Sufei Wang, MD, Union Hospital, and Huazhong University of Science and Technology, Wuhan, China, and colleagues.
The study included patients admitted with COVID-19 between January 24 and February 10, 2020 at 2 hospitals in Wuhan. Blood samples were collected after an overnight fast lasting at least 8 hours within 24 hours after admission. Of the patients, 276 (45.6%) had a fasting blood glucose >6.1 mmol/l accounted and 176 (29.1%) had fasting blood glucose ≥7.0 mmol/l.
“These results indicate that our study included both undiagnosed patients with diabetes and non-diabetic patients with hyperglycaemia caused by an acute blood-glucose disorder,” the authors wrote. “Similarly to a previous study, patients with COVID-19 might suffer from stress hyperglycaemia and critically ill patients may develop acute insulin resistance, manifested by hyperglycaemia and hyperinsulinaemia.”
Compared with survivors, more non-survivors were found among older people (median age, 66 vs 56 years; P < .0001), male sex (68.4% vs 49.7%; P = .0003), and patients with a past medical history (48.3% vs 31.2%; P = .0005). In terms of past medical history, cerebrovascular disease (6.1% vs 1.8%; P = .0098) was significantly higher in non-survivors than in survivors. In non-survivors, the percentages were higher in patients having a CRB-65 score of 3 to 4 and fasting blood glucose ≥7.0 mmol/l at admission.
“Fasting blood glucose can facilitate the assessment of prognosis and early intervention of hyperglycaemia to help improve the overall outcomes in the treatment of COVID-19.”