Glycated hemoglobin level on admission associated with progression to severe disease in hospitalized patients with non-severe coronavirus disease 2019

Ryutaro Numaguchi; Masafumi Kurajoh; Yoshikazu Hiura; Takumi Imai; Tomoaki Morioka; Mika Saito; Satoshi Shiraishi; Masanori Emoto; Yukio Nishiguchi

doi:10.1111/jdi.13845

Glycated hemoglobin level on admission associated with progression to severe disease in hospitalized patients with non-severe coronavirus disease 2019

J Diabetes Investig. 2022 Oct;13(10):1779-1787. doi: 10.1111/jdi.13845. Epub 2022 Jun 9.

Authors

Ryutaro Numaguchi¹, Masafumi Kurajoh², Yoshikazu Hiura¹, Takumi Imai³, Tomoaki Morioka², Mika Saito⁴, Satoshi Shiraishi⁵, Masanori Emoto², Yukio Nishiguchi⁶

Affiliations

¹ Department of Diabetes and Endocrinology, Osaka City Juso Hospital, Osaka, Japan.
² Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
³ Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
⁴ Department of Pediatrics, Osaka City Juso Hospital, Osaka, Japan.
⁵ Department of Respiratory Medicine, Osaka City Juso Hospital, Osaka, Japan.
⁶ Department of Surgery, Osaka City Juso Hospital, Osaka, Japan.

Abstract

Aims/introduction: Poor glycemic control is known to be associated with severe infection development. This retrospective observational study examined whether glycemic control before coronavirus disease 2019 (COVID-19) onset contributes to progression from non-severe to severe COVID-19.

Materials and methods: Glycated hemoglobin (HbA1c) was measured on hospital admission in 415 patients with non-severe COVID-19. The outcome was determined from time of hospital admission to severe progression, based on clinical practice guidelines for COVID-19 in Japan.

Results: The median value for HbA1c on admission was 6.1%, with diabetes present in 138 patients (33.3%). Among the total cohort, 93 (22.4%) progressed to severe COVID-19 with a median (interquartile range) time of 4 days (3-7 days), whereas 322 (77.6%) were discharged after 13 days (10-17 days). A multivariable Cox proportional hazards regression model showed that HbA1c level on admission was independently associated with progression to severe COVID-19 (hazard ratio for 1% increase 1.237, 95% confidence interval 1.037-1.475; P = 0.018), with findings consistent among several sensitivity analyses. In subgroup analyses, such an association was significant in patients with diabetes, as well as older age, current smoking habit, lower estimated glomerular filtration rate, higher C-reactive protein level, moderate II COVID-19, dyslipidemia and chronic respiratory disease, with no remarkable inconsistency among the subgroups. Finally, higher HbA1c level (≥7%) was more strongly associated with severe COVID-19 progression than diabetes.

Conclusions: The results suggest that poor glycemic control before COVID-19 onset contributes to progression from non-severe to severe COVID-19, even in patients with severe COVID-19 risk factors regardless of the presence of diabetes.

Keywords: COVID-19; Glycated hemoglobin; Severe progression.

Publication types

Observational Study

MeSH terms

C-Reactive Protein / analysis
COVID-19* / complications
COVID-19* / epidemiology
Diabetes Mellitus* / epidemiology
Glycated Hemoglobin / analysis
Humans
Hyperglycemia*
Retrospective Studies
Risk Factors

Substances

Glycated Hemoglobin A
C-Reactive Protein