Hemoglobin A1C is a Predictor of COVID‐19 Severity in Patients with Diabetes

Merzon, Eugene; Green, Ilan; Shpigelman, Miriam; Vinker, Shlomo; Raz, Itamar; Golan‐Cohen, Avivit; Eldor, Roy

INTRODUCTION: Poor outcomes of coronavirus disease 2019 (COVID‐19) have been linked to diabetes but its relation to pre‐infection glycemic control is still unclear. METHODS: To address this question we report here the association between pre‐infection HemoglobinA1c (A1C) levels and COVID‐19 severity as assessed by need for hospitalization in a cohort of 2068 patients with diabetes tested for COVID‐19 in Leumit Health Services, Israel, between February 1 and April 30, 2020. Using the LHS integrated electronic medical records system we were able to collect a large amount of clinical information including age, sex, socioeconomic status, weight, height, body mass index, A1C, prior diagnosis of ischemic heart disease, depression/anxiety, schizophrenia, dementia, hypertension, cerebrovascular accident, congestive heart failure , smoking and chronic lung disease. RESULTS: Of the patients included in the cohort, 183 (8.85 %) were diagnosed with COVID‐19 and 46 were admitted to hospital. More hospitalized patients were female, came from higher socioeconomic background and had a higher baseline A1C. A prior diagnosis of cerebrovascular accident and chronic lung disease conferred an increased risk of hospitalization but not obesity or smoking status. In a multivariate analysis, controlling for multiple prior clinical conditions, the only parameter associated with a significantly increased risk for hospitalization was A1C≥9%. CONCLUSION: Using pre‐infection glycemic control data we identify A1C as a clear predictor of COVID‐19 severity. Pre‐infection risk stratification is crucial to successfully manage this disease, efficiently allocate resources and minimize the economic and social burden associated with an undiscriminating approach. This article is protected by copyright. All rights reserved.