Individuals with pre-existing conditions, such as type 2 diabetes, have a demonstrated higher risk for developing more severe cases of coronavirus disease 2019 (COVID-19) infection, leading to higher morbidity and mortality. A new study sheds light on improving outcomes for patients with type 2 diabetes who are infected with the virus, suggesting that a focus on blood glucose (BG) control may be key.
For the study, which was published in Cell Metabolism, investigators performed a retrospective, multi-centered analysis of 7337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing type 2 diabetes.
The results showed that patients with type 2 diabetes 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 those without diabetes. Patients with diabetes registered a higher need for antibiotics, antifungal drugs, systemic corticosteroids, immunoglobin, anti-hypertensive drugs, and even vasoactive drugs, according to the data. Oxygen inhalation, noninvasive ventilation, and invasive ventilation was also more common in those with type 2 diabetes compared with those without.
However, the study showed that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared with individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization.
Patients from the well-controlled BR group also received less medical interventions, such as supplemental oxygen and/or ventilation, and had significantly lower incidences of lymphopenia, lower rates of increase counts of leukocyte and neutrophil, and elevated serum CRP and procalcitonin.
“We were surprised to see such favorable outcomes in well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes,” senior author Hongliang Li of Renmin Hospital of Wuhan University, said in a press release. “Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes.”
1. Hongliant L, Zhu L, She ZG, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metabolism. April 30, 2020. Doi: https://doi.org/10.1016/j.cmet.2020.04.021