Study highlights urgency of hyperglycaemia treatment in patients hospitalised with COVID-19
Severe hyperglycaemia shortly after admission to a non-ICU hospital setting in patients with COVID-19 is associated with a 7-fold increase in mortality risk, according to a study published in Diabetes Care.
The study by Klonoff et al. also showed that admission glucose was a strong predictor of death among patients directly admitted to the intensive care unit (ICU), further strengthening calls for prompt treatment to improve glycaemic control in patients hospitalised with COVID-19.
Previous studies have established that diabetes and hyperglycaemia increase the risk of poor outcomes in hospitalised patients with COVID-19, including disease severity, acute kidney injury, acute respiratory distress syndrome, ICU admissions and death. By careful examination of post-admission glycaemia, Klonoff and colleagues hypothesised that achieving glycaemic control in the first 2–3 days after hospital admission, in ICU and non-ICU, could affect outcomes in patients with COVID-19 and predict outcomes more effectively than glycaemia levels on admission.
The authors used the Glytec database, a pool of patient demographics, for patients with a COVID-19-positive laboratory test from 1st March to 8th May 2020. Individual- and event-level data from 1544 patients from 91 hospitals across 12 different states in the USA was extracted and analysed from the database. Before achieving patient glucose level soon after admission, the patients were grouped according to whether they were hospitalised in an ICU or a non-ICU setting. Patients were stratified according to 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, respectively. A survival analysis determined the association between glucose category and hospital mortality. The primary outcome was time to mortality.
Of the 1544 patients, 279 died in hospital. The results suggested that 2–3 days glycaemia levels predicted outcomes better than admission values for patients in a non-ICU setting but not for those admitted directly to ICU. Achieving a glucose value of ≤7.77 mmol/l (140 mg/dl) or 7.83–10 mmol/l (141–180 mg/dl) within 2 days after reaching ICU admission or between 2 and 3 days in the non-ICU setting, respectively, was associated with reduced mortality.
Higher survival rates of those with greater glycaemic control after admission compared with patients with uncontrolled glucose suggests the need to begin hyperglycaemia treatment on admission. The results were published in Diabetes Care in February 2021.
The views expressed in this article are those of the author, Dr Eleanor D Kennedy.