Unmanaged Diabetes as a Poor Prognostic Factor in the Severity of Infection and Recovery Time of Hospitalized COVID-19 Patients

Mossayebi, Ali Kreit Helen Cherukuri Sundar V.; Mandania, Roshni A.; Concha, Jeannie B.; Jung, Hyejin Wagler Amy E.; Gupte, Akshay A.; Deoker, Abhizith Bajpeyi Sudip

Diabetes is considered as one of the comorbidities with COVID-19 infection and indicated to influence the severity and the rate of recovery in COVID-19 patients. However, it is not known whether the lack of diabetes management may magnify COVID-19 severity and the rate of recovery in patients with diabetes. Purpose: The purpose of this study was to determine the effect of diabetes management on the severity and length of hospitalization in hospitalized COVID-19 patients. Methods: This retrospective study used medical records from patients admitted to the University Medical Center, El Paso, TX with COVID-19 (n=369;Age 60.0 ± 0.8 years;BMI 30.3 ± 0.4 Kg/m2). Glycemia was assessed by glycated hemoglobin (A1c) level at the time of hospitalization. The severity of the COVID-19 outcome was assessed by quick sepsis-related organ failure assessment (qSOFA) and length of hospitalization was determined by the number of days spent in the hospital. Patients were categorized into normoglycemic (N: A1c <5.7%), prediabetes (Pre: 5.7% ≤ A1c < 6.5%), and diabetes mellitus (DM: A1c ≥ 6.5%) groups. DM group was further categorized for diabetes management with medication. One-way ANOVA and unpaired t-test were used to determine the statistical differences among/between groups as appropriate. Results: There was no significant difference among groups in severity of COVID-19 infection (qSOFA: N 0.24 ± 0.08, Pre 0.38 ± 0.07, D 0.28 ± 0.03;p>0.05) and length of hospitalization (N 5.6 ± 0.8, Pre 9.3 ± 1.0, DM 8.9 ± 0.6 days;p>0.05). However, patients with unmanaged diabetes (no medication) showed significantly greater severity (qSOFA: 0.44 ± 0.08 vs. 0.22 ± 0.03;p<0.05) and length of hospitalization (10.8 ± 1.6 vs. 8.2 ± 0.6 days;p<0.05) compared to patients who managed diabetes with medication. Conclusion: Unmanaged diabetes shows worsened severity and the rate of recovery in COVID-19 patients. Diabetes management should be considered in the treatment of COVID-19 patients.