Improved glycemia within the first two or three days of hospitalization is a better predictor of outcomes in COVID-19 patients than glycemia at the time of non-intensive-care-unit (ICU) hospital admission, according to new findings.
Glycemia soon after direct ICU admission was not predictive of outcomes in these patients, Dr. David C. Klonoff, medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center in San Mateo, California, and colleagues report.
“These findings contradict the idea that admission hyperglycemia is destiny,” Dr. Klonoff told Reuters Health by email.
Diabetes and stress hyperglycemia are risk factors for hospitalization, severe illness and death in patients with coronavirus disease 2019, he and his colleagues note in Diabetes Care. However, they add, patients with diabetes or stress hyperglycemia who achieve glycemic targets early in hospital admission may have better outcomes.
To investigate, the authors analyzed deidentified data on 1,544 COVID-19 patients from 91 hospitals in 12 U.S. states from Glytec’s national database. (Glytec is a Massachusetts-based company that makes insulin-management software for health care workers).
Hospital mortality was 18.1 percent. Non-ICU patients with blood glucose (BG) above 13.88 mmol/L (250 mg/dL) on hospital days 2-3 were significantly more likely to die in the hospital (adjusted hazard ratio, 7.17) than those with BG below 7.77 mmol/L (140 mg/dL). Glucose levels on admission were not associated with mortality in the non-ICU patients.
However, glucose levels at admission were significantly linked to mortality in the patients admitted directly to the ICU (aHR, 3.14), but their day-2 glucose levels did not significantly predict mortality (HR, 1.40, 95 percent confidence interval, 0.53 to 3.69).
Patients with hypoglycemia (BG below 70 mg/dL) also had a significantly higher risk of dying in the hospital (odds ratio, 2.2).
“People with diabetes are prone to hyperglycemia at the time when they are admitted to the hospital with COVID-19, and higher admission concentrations have been linked to worse outcomes,” Dr. Klonoff said. “In this study we demonstrated that for these patients, improved glucose levels are associated with better outcomes. Our results of nearly eight-fold increased risk for death in non-ICU patients with COVID-19 and severe hyperglycemia highlights the need to initiate treatment with standard-of-care regimens known to work in controlled settings.”
Dr. Klonoff noted that elevated blood glucose may have been deprioritized early in the pandemic, when the focus was on oxygen levels and maintaining open airways.
“Now that we have more experience, many hospitalized COVID-19 patients routinely receive oxygen therapy, antivirals, anticoagulants, and corticosteroids as basic care,” he added. “This article underscores the need for bringing down elevated blood glucose levels soon after admission as part of routine care in patients who also have diabetes.”
Five of the authors worked at Glytec when the study was written, and Dr. Klonoff has consulted for several pharmaceutical and medical technology companies.