Hyperglycemia at Hospital Presentation Associated with Severity and Mortality in COVID-19 Patients without Type 2 Diabetes

Charoenngam, Nipith Holick Michael F.; Apovian, Caroline

There is a bidirectional association between hyperglycemia (HG) and COVID-19 severity. We conducted a retrospective cohort study in COVID-19 patients aged ≥18 years hospitalized at the Boston Medical Center during March 1 - August 4, 2020 with the aim to determine the relationships among HG, presence of type 2 diabetes (T2D) and outcomes of COVID-19. Blood glucose levels (BG) measured on admission were extracted from the hospital database. HG was defined as BG >200 mg/dL. Patients with type 1 diabetes or BG <70 mg/dL were excluded. Outcomes were in-hospital death and intensive care unit (ICU) admission. Multivariate analysis was used to determine the associations between exposures and outcomes. A total of 1,434 patients were included in the analysis. The mean ± SD age was 56 ± 17 years, 642 (45%) were female and 458 (32%) had a history of T2D. HG occurred in 193 patients with T2D (42%) and 42 patients without T2D (4%). The rates of death and ICU admission were 9% and 19%, respectively. Among patients without T2D, after adjusting for age, sex, body mass index, race and comorbidities, patients with HG had a significantly higher odds of death (aOR 4.5, 95%CI 1.8 - 11.2) and ICU admission (aOR 3.7, 95%CI 1.8 - 7.5) than patients without HG. Among patients with T2D, patients with HG had a significantly higher odds of ICU admission (aOR 1.7, 95%CI 1.0 - 2.8) and tended to have a higher odds of death (aOR 1.6, 95%CI 0.8-3.0) than patients without HG after adjusting for potential confounders. Among the 235 patients with HG, the odds of death and ICU admission were higher in the 42 HG patients without T2D than the 193 patients with T2D (death: aOR 5.1, 95%CI 1.3 - 19.0;ICU admission: aOR 2.7, 95%CI 1.1 - 6.7) after adjusting for potential confounders including BG. HG in the subset of patients without T2D could be a marker of high inflammatory burden leading to higher mortality or undiagnosed diabetes leading to increased severity of COVID-19 due to metabolic dysfunction.