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COVID-19 Severity Perceived in Recently Diagnosed Diabetes Patients

Nov 24, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy

Newly-diagnosed diabetes and admission hyperglycemia are linked to rapid respiratory deterioration in COVID-19 patients.  

The severity of the COVID-19 virus is detrimental to most people, especially those who have many comorbidities. COVID-19 severity in patients who had pre-existing diabetes, newly diagnosed, and admission with hyperglycemia was investigated; the study’s purpose was to determine if either factor caused COVID-19 to be worse. Some meta-analysis studies concluded that diabetes has a more significant increase rate for poor disease outcomes when diagnosed with COVID-19. Another study conducted stated that diabetes was related to much higher mortality; patients with better glycemic control had lower mortality, and that to reduce COVID-19 severity, it is best to control glycemic management.  

The investigation of COVID-19 severity by pre-existing diabetes, newly diagnosed, and admission with hyperglycemia was a retrospective study. The following data were collected from the participants: positive PCR test for SARS-CoV-2, pre-existing diabetes was self-reported, newly diagnosed diabetes determined by an HBA1c of 6.5% or higher, and glucose levels of 200 mg/dl or higher. The study examined the major laboratory exams such as fasting plasma glucose, Hb1A1c, lipid profile, serum creatinine, white blood cell counts, C-reactive protein, and more. The primary outcome was evaluating admission to the ICU or death. Secondary effects were examined by being discharged alive and the time to release.   

The retrospective study was analyzed among hospitalized patients with COVID-19 during February and April of 2020. The robust-error-variance Poisson regression model determined the association between diabetes and glucose levels. Multivariable adjusted models were used to account for confounding factors. The Cox proportional hazard model was used to examine the patients’ likelihood of being discharged alive.  

In this study, 423 patients tested positive for COVID-19, and 107 had diabetes, with 86 patients pre-existing and 21 newly diagnosed with diabetes. The outcome showed that patients with diabetes had a higher rate of compromised respiratory function, including lower oxygen saturation and higher respiratory rates. Patients with diabetes compared by pre-existing vs. newly diagnosed showed a higher incidence of the primary outcome at 37.4% vs. 20.3%; relative rate 1.85; 95% CI (.33-2.57); p-value < 0.001.  When comparing patients who do not have diabetes to newly diagnosed diabetes, there was a stronger increase in the primary outcome than pre-existing diabetes with a (RR 1.55, 95% CI (1.06-2.27); statistically significant with a P-value of 0.004.  COVID-19 severity was associated with a higher fasting plasma (FPG) glucose reading with an increase in RR at 21% (RR 1.21; 95% CI (1.11-1.32); P-value < 0.001); seen with 36 mg/dl increase in FPG.  Mortality rates were similar between the patients with or without diabetes seen at 10.8 vs. 14.0% with RR 1.30; 95% CI (0.74-2.30); P-value 0.367. Patients with diabetes discharged alive were much lower compared to pre and newly diagnosed diabetes patients, with 56.1% vs 77.8%; P-value < 0.001. 

The authors reported a decline in respiratory function to seem to be a significant factor in hyperglycemia’s dangerous effect on COVID-19 severity.  They concluded that patients with newly identified diabetes with hyperglycemia at admissions had a more vital link with the COVID-19 severity outcome than pre-existing diabetes, with a 15% increase in the progression of the severity of COVID-19 in patients with 36 mg/dl higher admission glucose readings. These indications were more substantial in newly diagnosed patients. Other studies shared similar results showing that diabetes and hyperglycemia caused pulmonary disease leading to a decline in respiratory function.  The retrospective case did have a few limitations:  all clinical variables were not collected for all patients, absence of data for the body mass index, HBA1c was not made available for all participants. The study’s strengths were that they included detailed clinical classification of the patients and biochemical inflammatory markers.  The trial is of interest because people are being diagnosed with diabetes every day.  With the current pandemic of COVID-19, it is imperative to know the severity of the virus with all disorders. The study will guide to better prevention and treatment for future patients with COVID-19 and diabetes. Future studies should be generalized to the younger population of newly diagnosed diabetes patients with COVID-19 to include all ages.  

Practice Pearls: 

  • COVID-19 severity, as seen in newly diagnosed diabetes patients, has a higher mortality rate. 
  • Patients who do not know they have diabetes but have higher glucose readings may have the worst outcome of contracting COVID-19. 
  • Hyperglycemia is a vital factor in determining the outcome of a patient’s life during COVID-19. 

 

Fadini G.P., Morieri M.L., Boscari F., Fioretto P., Maran A., Busetto L., Bonora B.M., (…), Vettor R. newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. (2020)  Diabetes Research and Clinical Practice  

 

Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy

 

 

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