Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

• Published in: Journal of diabetes science and technology 2020-07, Vol.14 (4), p.813-821
• Main Authors: Bode, Bruce, Garrett, Valerie, Messler, Jordan, McFarland, Raymie, Crowe, Jennifer, Booth, Robby, Klonoff, David C.
• Format: Article
• Language: English
• Subjects: Aged; Betacoronavirus; Blood Glucose Self-Monitoring - methods; Comorbidity; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; COVID-19; Data Collection; Female; Glycated Hemoglobin A - analysis; Hospitalization; Humans; Hyperglycemia - complications; Hyperglycemia - epidemiology; Hyperglycemia - therapy; Insulin Infusion Systems; Length of Stay; Male; Middle Aged; Original; Pandemics; Patient Discharge; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Respiratory Distress Syndrome - complications; Retrospective Studies; Risk Factors; SARS-CoV-2; Software; Treatment Outcome; United States - epidemiology
• ISSN: 1932-2968; 1932-2968; 1932-3107
• DOI: 10.1177/1932296820924469

Introduction: Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia. Methods: This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec’s data warehouse. Results: Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001). Conclusion: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.