Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes.

Lihua Zhu, Zhi-Gang She, Xu Cheng, Juan-Juan Qin, Xiao-Jing Zhang, Jingjing Cai, Fang Lei, Haitao Wang, Jing Xie, Wenxin Wang, Haomiao Li, Peng Zhang, Xiaohui Song, Xi Chen, Mei Xiang, Chaozheng Zhang, Liangjie Bai, Da Xiang, Ming-Ming Chen, Yanqiong Liu, Youqin Yan, Mingyu Liu, Weiming Mao, Jinjing Zou, Liming Liu, Guohua Chen, Pengcheng Luo, Bing Xiao, Changjiang Zhang, Zixiong Zhang, Zhigang Lu, Junhai Wang, Haofeng Lu, Xigang Xia, Daihong Wang, Xiaofeng Liao, Gang Peng, Ping Ye, Jun Yang, Yufeng Yuan, Xiaodong Huang, Jiao Guo, Bing-Hong Zhang, Hongliang Li

Journal: Cell metabolism 2020;31(6):1068-1077.e3

PMID: 32369736

Plain Language Summary

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The novel coronavirus disease 2019 (COVID-19) is caused by infection from the newly emerged, highly contagious coronavirus SARS-CoV-2. The aim of this study was to analyse the association between plasma glucose levels and clinic outcomes in COVID-19 patients with type 2 diabetes (T2D). The study is a retrospective longitudinal, multi-centre study from a cohort of 7,337 COVID-19 cases enrolled among 19 hospitals. Results show that patients with pre-existing T2D received significantly more intensive integrated treatments to manage their symptoms of COVID-19 than the non-diabetic subjects. Furthermore, findings indicate that well-controlled blood glucose was associated with a markedly improved outcome of patients with COVID-19 and pre-existing T2D. Authors conclude that T2D is an important risk factor for COVID-19 progression and adverse endpoints, and well-controlled blood glucose is associated with a significant reduction in the composite adverse outcomes and death.

Abstract

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.

Copyright © 2020 Elsevier Inc. All rights reserved.

Address: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.; Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410000, China.; Institute of Model Animal, Wuhan University, Wuhan 430072, China.; Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China.; Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.; Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430072, China.; Wuhan Seventh Hospital, Wuhan 430072, China.; The Ninth Hospital of Wuhan City, Wuhan 430072, China.; Department of General Surgery, Huanggang Central Hospital, Huanggang 438000, China.; Department of Pulmonary and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430072, China.; Department of General Surgery, Ezhou Central Hospital, Ezhou 436000, China.; Department of Neurology, Wuhan First Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan 430072, China.; Department of Urology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China.; Department of Stomatology, Xiantao First People's Hospital, Xiantao 433000, China.; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.; The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.; Department of Neurology, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000, China.; Department of Orthopedics, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000 China.; Department of Hepatobiliary Surgery, The First Affiliated Hospital of Changjiang University, Jingzhou 434000, China.; Department of Hepatobiliary Surgery, Jingzhou Central Hospital, Jingzhou 434000, China.; Department of Hepatobiliary and Pancreatic Surgery, Xianning Central Hospital, Xianning 437000, China.; Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China.; Department of Hepatobiliary and Pancreatic Surgery, Suizhou Central Hospital Affiliated to Hubei Medical College, Suizhou 441300, China.; Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University and Yichang Central People's Hospital and Institute of Cardiovascular Diseases, China Three Gorges University, Yichang 443000, China.; Department of Gastroenterology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China. Electronic address: [email protected].; Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine & Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China and Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou 510006, China. Electronic address: [email protected].; Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan 430072, China. Electronic address: [email protected].; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China; Basic Medical School, Wuhan University, Wuhan 430072, China. Electronic address: [email protected].
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