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New research finds that high blood sugar levels are related to COVID-19 mortality, even in people with no history of diabetes. The findings suggest the need for early blood glucose screening in people with SARS-CoV-2 infections.
Who is at risk of dying from COVID-19? Ongoing research has identified vulnerable populations, including people with immunocompromised states, people aged 65 and over, and people with underlying health conditions. However, it is still unclear why COVID-19 can be deadly even for people who are not part of high-risk groups.
Since excess blood sugar is linked to type 2 diabetes, a major risk factor for severe COVID-19 and death, a team of researchers in Spain investigated whether high blood sugar levels alone are related to COVID-19 related mortality.
The results of their study appear in the journal Annals of Medicine.
The researchers used a national registry to analyze data from 11,312 COVID-19 positive patients in 109 hospitals in Spain from March 1 to May 31, 2020. Patients were excluded from the study if they had repeated hospital visits or did not provide informed consent.
The registry information included, but was not limited to, treatments, laboratory test results, and symptoms. The mean age of the patients was 67.06 years and 57.1% were male.
The researchers assumed that patients had diabetes if there was a record of the diagnosis or evidence of diabetes drug use prior to hospital admission. Only 18.9% of the patients in the study were diagnosed with diabetes.
Blood sugar levels were detected upon admission to hospital, and the team used this information to classify patients into three groups: normal, high, and very high blood sugar.
The researchers found that high blood sugar levels were associated with older men with a history of diabetes, hypertension, or other health conditions. The team also observed elevated levels of inflammation markers more frequently in patients with elevated blood sugar levels.
One of the most important findings was that as blood sugar levels rose, the risk of death from COVID-19 also increased. This association was not influenced by a history of diabetes.
Of the 11,312 patients included in the study, 2,289 – or 20.2% – died from COVID-19. In this group, 41.1% had very high blood sugar levels, while 15.7% had normal levels.
Patients with very high blood sugar levels were hospitalized for a slightly longer period than those with normal levels. They also required a higher frequency of intensive care units and more invasive or non-invasive ventilation.
The first limitation concerns the design of the study: it was an observational and retrospective cohort study. The researchers looked at patient admissions records to study how specific symptoms and other characteristics influenced their findings. Unlike an experiment, the researchers were unable to measure or control external variables.
The authors also acknowledged that most of the inflammatory markers were not included in the registry. This is important because many are related to the severity of the COVID-19 disease.
Recently, a study in Medicine of naturefound that inflammatory markers such as elevated serum levels of interleukin 6, interleukin 8, and tumor necrosis factor-alpha were strong predictors of COVID-19 survival.
Additionally, some patients did not know their diabetes status because they did not have measurements of the average blood glucose level. This leaves the possibility of biased results, as patients who had diabetes may have been mistakenly assigned to a non-diabetic group.
Despite the numerous shortcomings, however, the authors stress the importance of their study: Most COVID-19 studies focus on critically ill patients, leaving limited data on others who are not in critical condition.
“On the other hand, as a strength, our registry is made up of the largest available cohorts of patients admitted to non-critical conditions with confirmed COVID-19. […] It includes data from over 11,000 patients upon admission [and their blood glucose] levels before starting any treatment, “the researchers point out.
Improved mortality rates may require refinement of COVID-19 protocols to include blood glucose screenings upon admission to hospital.
“Early glycemic control may be a suitable therapeutic option to reduce negative outcomes in hospitalized hyperglycemic COVID-19 patients with or without a previous diagnosis of diabetes,” the study authors write.
Inpatient blood glucose screenings may be essential to prioritize treatment for patients at high risk of death from COVID-19.
This early intervention would be particularly useful for racial and ethnic groups with a predisposition to type 2 diabetes and who have been disproportionately affected by the COVID-19 pandemic.
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