Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients With COVID-19: A Multicenter, Retrospective Hospital-Based Analysis

• Type of Material: Article
• Authors: David C. Klonoff, Mills Peninsula Medical Center; Jordan C. Messler, Glytec; Guillermo Umpierrez, Emory University; Limin Peng, Emory University; Robby Booth, Glytec; Jennifer Crowe, Glytec; Valerie Garrett, Glytec; Raymie McFarland, Glytec; Francisco Pasquel, Emory University
• Language: English
• Date: 2021-02-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the American Diabetes Association
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2337/dc20-1857
• Title of Journal or Parent Work: Diabetes Care
• Volume: 44
• Issue: 2
• Start Page: 578
• End Page: 585
• Grant/Funding Information: F.J.P. is supported in part by NIH awards 1K23GM128221-01A1, P30DK111024, and P30DK111024-05S1 and has received unrestricted research support from Merck and Dexcom and consulting fees from Boehringer Ingelheim.; G.E.U. is partly supported by research grants from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under award UL1TR002378 from the Clinical and Translational Science Award program and NIH grant U30 P30DK11102 and has received research grant support to Emory University for investigator-initiated studies from Novo Nordisk, Dexcom, and AstraZeneca.
• Keywords: Management; Glucose control; Science & Technology; Life Sciences & Biomedicine; Blood glucose; Cardiac arrest; Endocrinology & Metabolism; Target
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVE Diabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19. RESEARCH DESIGN AND METHODS We analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category in mg/dL (£7.77, 7.83–10, 10.1–13.88, and >13.88 mmol/L; £140, 141–180, 181–250, and >250 mg/dL) during days 2–3 in non-ICU patients or on day 2 in ICU patients. We conducted a survival analysis to determine the association between glucose category and hospital mortality. RESULTS Overall, 18.1% (279/1,544) of patients died in the hospital. In non-ICU patients, severe hyperglycemia (blood glucose [BG] >13.88 mmol/L [250 mg/dL]) on days 2–3 was independently associated with high mortality (adjusted hazard ratio [HR] 7.17; 95% CI 2.62–19.62) compared with patients with BG <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR 1.465; 95% CI 0.683– 3.143). In patients admitted directly to the ICU, severe hyperglycemia on admission was associated with increased mortality (adjusted HR 3.14; 95% CI 1.44–6.88). This relationship was not significant on day 2 (HR 1.40; 95% CI 0.53–3.69). Hypoglycemia (BG <70 mg/dL) was also associated with increased mortality (odds ratio 2.2; 95% CI 1.35–3.60). CONCLUSIONS Both hyperglycemia and hypoglycemia were associated with poor outcomes in patients with COVID-19. Admission glucose was a strong predictor of death among patients directly admitted to the ICU. Severe hyperglycemia after admission was a strong predictor of death among non-ICU patients.