Hyperglycemia in Hospitalized COVID-19 Patients Linked with Worse Outcomes

March 22, 2021
Grace Halsey

ENDO 2021

COVID-19 patients with hyperglycemia on hospital admission, with and without diabetes, had increased odds of intubation, ICU admission, and mortality, according to research presented at ENDO 2021.

Elevated glucose at hospital admission among patients with COVID-19 increased the odds of mortality in patients both with and without diabetes, according to findings presented at ENDO 2021, the Endocrine Society's annual meeting.

Investigators found that hyperglycemia on admission to the hospital also was associated with greater likelihood of requiring a respirator or admission to intensive care.

"COVID-19 patients presenting to the hospital with hyperglycemia require closer observation, as they are likely to require more aggressive therapies,” said the study’s lead investigator, Samara Skwiersky, MD, MPH, an internal medicine resident at the State University of New York (SUNY) Downstate Medical Center in Brooklyn, NY, in an Endocrine Society press release.

The retrospective cohort study analyzed data from all adults admitted to a designated COVID-19 hospital in Brooklyn, NY, from March 1 to May 15, 2020. Patients with diabetes were compared to those without diabetes and were further stratified based on admission glucose levels of <140 and <180 mg/dL. Diagnosis of diabetes was based on history and/or A1c >6.5%.

Using univariate, multivariate, and logistic regression models, researchers analyzed outcomes for mortality, intubation, ICU admission, acute kidney injury (AKI), and length of stay stratified by admission glucose levels. Analyses were controlled for age, gender, lab values (serum creatinine and white blood cell count), and comorbidities (eg, hypertension, cardiovascular disease, obesity).

Results

A total of 708 adults were included (mean age, 68 years; 51% men; 83.5% Black; 54% with diabetes)

  • Hospital length of stay was 37% greater in those with diabetes (13±26 days) vs those without (9.5±18.5) (p<.05).
  • Patients with diabetes and admission glucose >140 mg/dL (vs<140 g/dL) had 2.4-fold increased odds of both intubation and ICU admission (95% CI: 1.2, 4.5; 1.3, 4.6).
  • Patients with diabetes and admission glucose >180 mg/dL (vs <180 g/dL) had a 1.8-fold increased mortality (95% CI: 1.2, 2.9).
  • Patients without diabetes and admission glucose levels >140 mg/dL (vs<140 g/dL) also had twofold greater odds of mortality (95% CI: 1.2, 3.5). This group also had 3.5-fold increased odds of ICU admission (95% CI: 1.8,6.6) and 2.3-fold increased odds of both intubation and AKI (95% CI: 1.3, 4.2; 1.3,4.2).
  • In patients without diabetes and admission glucose levels >180 mg/dL (vs <180 g/dL) mortality risk was increased four-fold (95% CI: 1.8, 8.8), odds of intubation increased 2.7-fold (95% CI: 1.3, 5.6) and odds of ICU admission increased by 2.9-fold (95% CI: 1.3, 6.2).

The authors note that whether hyperglycemia can be considered a marker for or cause of more severe COVID-19 remains unknown. They conclude, however, that elevated glucose “portends worse outcomes” regardless of diabetes status and that these patients warrant closer observation and more aggressive treatment, including intensive glucose control.

“More frequent glucose monitoring and treatment with insulin therapy to a target glucose value less than 140 mg/dL could improve outcomes in these patients,” concluded Skwiersky in the press release.

The study is described in the Endocrine Society press release as the first known study of the impact of hyperglycemia on a largely Black population with SARS-CoV-2 infection.

Reference: Skwiersky S, Rosengarten S, Chang M, et al. Sugar is not always sweet: exploring the relationship between hyperglycemia and COVID-19 in a predominately African American population.

For more coverage of ENDO 2021, please click here.