Table 3.
Overview of the risk of adverse COVID-19-related outcomes according to glycemic control.
| Study population | Number of patients (n) | Parameter of glycemic control | Outcome | Risk HR/OR (95% CI) | |
|---|---|---|---|---|---|
| a. Glycemic control before hospitalization | |||||
| Holman et al. (10) | United Kingdom, nationwide population-based cohort | T1D: 265,090 T2D: 2,889,210 |
HbA1c 59 – 74 mmol/mol (7.6 – 8.9%) | Mortality | T1D: HR 1.16 (0.81 – 1.67)* T2D: HR 1.22 (1.15 – 1.30)* |
| March 1st – May 11th 2020 | HbA1c 75 – 85 mmol/mol (9.0 – 9.9%) | T1D: HR 1.37 (0.90 – 2.07)* T2D: HR 1.36 (1.24 – 1.50)* |
|||
| HbA1c ≥ 86 mmol/mol (10.0%) | T1D: HR 2.23 (1.50 – 3.30)* T2D: HR 1.61 (1.47 – 1.77)* |
||||
| Williamson et al. (58) | United Kingdom, nationwide population-based cohort | 17,278,392 | HbA1c ≥ 58 mmol/mol (7.5%) | Mortality | HR 2.61 (2.46 – 2.77)#
HR 1.95 (1.83 – 2.08)$ |
| January 1st – May 6th 2020 | |||||
| Cariou et al. (60) | France, multi-center cohort March 10th – March 31st 2020 |
846 | HbA1c 53 – 63 mmol/mol (7.0 – 7.9%) HbA1c 64 – 74 mmol/mol (8.0 – 8.9%) HbA1c ≥ 75 mmol/mol (9.0%) |
Mortality | OR 1.55 (0.82 – 2.93)&
OR 1.09 (0.52 – 2.28)& OR 0.84 (0.40 – 1.75)& |
| Gregory et al. (51, 52)Φ | USA, single-center cohort March 17th – December 24th 2020 |
T1D: 102 | 1st HbA1c quartile 2nd HbA1c quartile 3rd HbA1c quartile 4th HbA1c quartile |
Hospitalization | OR 2.96 (1.11 – 7.86)€
OR 2.96 (1.11 – 7.86)€ OR 5.12 (2.12 – 12.35)€ OR 9.76 (4.42 – 21.54)€ |
| b. Glycemic control at the time of hospitalization | |||||
| Wang et al. (141) | China, multi-center retrospective January 24th – February 10th 2020 |
605 | Fasting blood glucose level ≥ 7.0 mmol/l (126 mg/dL) | Mortality In-hospital complications |
HR 2.30 (1.49 – 3.55)~
OR 3.99 (2.71 – 5.88)& |
| Wu et al. (18) | China, multi-center retrospective December 26th 2019 – March 15th 2020 |
2,041 | Hyperglycemia ≥ 6.1 mmol/l (110 mg/dL) | Critical disease and mortality overall Mortality in critical patients |
HR 1.30 (1.03 – 1.63)£
HR 1.84 (1.14 – 2.98)£ |
| Copelli et al. (17) | Italy, single-center retrospective | 271 | Hyperglycemia ≥ 7.78 mmol/l (140 mg/dL) | Critical disease and mortality | HR 1.80 (1.03 – 3.15)¥ |
| March 20th – April 30th 2020 | |||||
| c. Glycemic control during in-hospital stay | |||||
| Bode et al. (20) | USA, multi-center retrospective | 1,122 | Diabetes and/or uncontrolled hyperglycemia (≥ 2 measurements > 10.0 mmol/l (180 mg/dL) within 24h) | Mortality | OR 6.12 (3.63 – 10.31)&φ |
| March 1st – April 6th 2020 | |||||
| Zhu et al. (19) | China, multi-center retrospective December 30th 2019 – March 20th 2020 |
Total: 7,337 | Normoglycemia (glycemic variability during hospital stay 3.9 – 10.0 mmol/l (70 – 180 mg/dL) versus hyperglycemia (> 10.0 mmol/l (180 mg/dL) | Mortality | HR 0.14 (0.03 – 0.60)ω |
| T2D: 952 | |||||
COVID-19, coronavirus disease 2019; T1D, type 1 diabetes; T2D, type 2 diabetes; HR, hazard ratio; OR, odds ratio; CI, confidence interval; USA, United States of America.
Φ Gregory et al. have published the initial findings of their prospective cohort study, followed by a report of further analyses on an even higher number of patients. Here, we report the findings of their latest analyses.
* Adjusted for age, sex, socioeconomic deprivation, ethnicity, region of residence, duration of diabetes, body mass index (BMI), systolic blood pressure, prescription for antihypertensive drugs, serum total cholesterol, prescription for statins, smoking status, history of myocardial infarction, stroke, heart failure and eGFR.
# Adjusted for age and sex.
$ Adjusted for age, sex, obesity, smoking status, deprivation, cancer, reduced kidney function, asthma, chronic respiratory disease, chronic cardiac disease, hypertension, chronic liver disease, stroke, dementia, other neurological disease, organ transplant, asplenia, rheumatoid arthritis, lupus or psoriasis and any other immunosuppressive condition.
& Unadjusted.
€ Adjusted for age, sex, ethnicity, hypertension, smoking, and body mass index (BMI).
~ Adjusted for age, sex and CRB-65 score (measure of pneumonia severity).
£ Adjusted for age, sex, hypertension, smoking, insulin treatment, glucocorticoids, chronic kidney disease, chronic obstructive pulmonary disease, cancer and admission white cell counts, lymphocyte counts, D-dimer, aspartate transaminase, alanine transaminase and creatinine.
¥ Adjusted for age, sex, hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease and cognitive impairment.
φ Calculated from data provided in the original paper.
ω Adjusted by propensity score matching, including age, sex, severity of COVID-19, hypertension, cardiovascular disease, cerebrovascular disease, chronic liver disease and chronic kidney injury.