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This retrospective study analyzed data from 413 patients admitted to a hospital in Northeast Italy between February and April 2020. It aimed to assess whether pre-existing diabetes, newly diagnosed diabetes, and admission hyperglycemia were independently associated with severity of COVID-19. The primary outcome—a composite of ICU admission or death—occurred in 37.4% of patients with diabetes compared with 20.3% of those without. The association was stronger for newly diagnosed diabetes than for pre-existing diabetes. Higher glucose level on admission was associated with increased COVID-19 severity, especially among those without pre-existing diabetes. The association of admission glucose with adverse outcomes was mediated mainly by worsened respiratory function.
Newly diagnosed diabetes and hyperglycemia on admission are strong predictors of COVID-19 severity and are related to respiratory deterioration.
This abstract is available on the publisher's site.
We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders.
We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death.
413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p<0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p=0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p<0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function.
Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.
Newly-Diagnosed Diabetes and Admission Hyperglycemia Predict COVID-19 Severity by Aggravating Respiratory Deterioration
Diabetes Res. Clin. Pract. 2020 Aug 14;[EPub Ahead of Print], G Paolo Fadini, M Luca Morieri, F Boscari, P Fioretto, A Maran, L Busetto, B Maria Bonora, E Selmin, G Arcidiacono, S Pinelli, F Farnia, D Falaguasta, L Russo, G Voltan, S Mazzocut, G Costantini, F Ghirardini, S Tresso, A Maria Cattelan, A Vianello, A Avogaro, R Vettor