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15-02-2021 | Diabetes | News | Article

Glycemic fluctuations linked to poor COVID-19 outcomes

Author: Claire Barnard

medwireNews: Elevated glucose levels and glycemic fluctuations during the first week of hospitalization for COVID-19 are associated with an increased risk for unfavorable outcomes, research suggests.

The study included 548 people with COVID-19 (median age 57 years, 54% women) who were admitted to the Central Hospital of Wuhan in China between January and February 2020, of whom 18% had diabetes. In all, 39% of the study population experienced acute respiratory distress syndrome (ARDS) and 11% died.

Liegang Liu (Huazhong University of Science and Technology, Wuhan) and colleagues report that individuals with higher peak and mean glucose levels, and those with a larger degree of fluctuation in glucose levels, in the week following hospital admission had a higher risk for subsequent ARDS and mortality, and “these associations seemed to occur in a dose-dependent manner.”

For instance, in a model adjusting for factors including age, sex, comorbidities, glucocorticoid use, and C-reactive protein levels, people with average glucose levels of 6.1–7.8 mmol/L (110.0–140.6 mg/dL) had a significant 2.8-fold higher mortality risk than those with average levels of 6.1 mmol/L or lower, rising to a sixfold increased risk for people with levels of 7.8–10.0 mmol/L (140.6–180.2 mg/dL) and a 12.2-fold increased risk for those with levels above 10.0 mmol/L.

Each standard deviation (SD) increase in log-transformed mean glucose levels was associated with a 2.4-fold increased mortality risk, while each SD increase in peak glucose levels was associated with a 1.9-fold increased risk.

Using the same model, Liu et al found an analogous pattern of results with increasing glycemic variability according to SD of week 1 glucose (GSD), calculated as the square root of the variance of daily fasting glucose levels. Compared with people who had a GSD of 0.4 mmol/L (7.3 mg/dL) or less, those with a GSD of 0.9–1.8 mmol/L (16.3–32.5 mg/dL) had a 1.9-fold increased mortality risk, while those with a GSD of more than 1.8 mmol/L had a 2.7-fold increased risk. Each SD increment of log-transformed GSD was associated with a significant 1.8-fold higher mortality risk.

Similarly, for ARDS, each SD increase in log-transformed mean and peak glucose levels was associated with a significant 1.5-fold elevated risk, while each SD increase in log-transformed GSD was associated with a 1.3-fold increase in risk.

Liu et al note that previous research has identified diabetes status and fasting glucose at the time of admission as factors associated with COVID-19 prognosis, whereas their study is the first to demonstrate an impact of glucose variability.

“These results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization,” they conclude in Diabetes Care.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

15 February 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Diabetes Care 2021; doi:10.2337/dc20-0780

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