Gagan Kumar, MD, MA, MS
Northeast Georgia Medical Center
Gainesville, Georgia
Disclosure information not submitted.
David Jefferies, APNP
APNP
Northeast Georgia Health System, Gainesville, GA, United States
Disclosure information not submitted.
Dhaval Patel, MD
Intensivist
Northeast Georgia Health System, United States
Disclosure information not submitted.
Rahul Nanchal, MD, MS, FCCM
Physician
Medical College of Wisconsin
Delafied, Wisconsin, United States
Disclosure information not submitted.
Title: Is Uncontrolled Diabetes Prior to Hospitalization A Risk Factor for Worse Outcomes in COVID19?
Introduction: Diabetes is a known risk factor for COVID19 infection. Whether uncontrolled DM prior to admission portends poorer outcomes in COVID-19 is not well known.
Methods: We performed a retrospective analysis of all adult COVID-19 patients (age ≥18 years) admitted to a large tertiary care hospital between March 1, 2020 to March 10th, 2021. Our primary outcome was in-hospital mortality. Other outcomes studied were severity of COVID19 at admission using 4C score and severity during the admission using rate of intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV) and use of vasopressors. We also examined rate of hospital associated infections (HAI) and rate of readmissions. We used restricted cubic splines with logistic regression to examine the probability of outcomes with various levels of hemoglobin A1C (HbA1c).
Results: 5204 patients were admitted in the study period of which 2289 (43.9%) were diabetic. HbA1c data was available for 1533 patients. The severity of COVID19 on admission as per 4C score was lower with higher HbA1c levels. However, the rates of ICU admission, IMV, vasopressor use, and HAI did not increase significantly with higher levels of HbA1c. The probability of in-hospital mortality and rate of readmissions decreased with increasing levels of HbA1c. Odds for in hospital mortality were 0.44 (95%CI 0.19-0.99) at HbA1c level of 14 when compared to 7.
Conclusion: Poorly controlled diabetes as judged by higher HbA1c had less severe COVID infection on admission, however, it was not associated with higher severity of COVID19 during the admission. Higher HbA1c level was associated with lower in-hospital mortality and rate of readmissions.