Hyperglycemia, male sex, older age, not HbA1c, related to higher COVID-19 mortality risk
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Among adults with type 2 diabetes hospitalized with COVID-19, men, older adults and those with hyperglycemia had increased risks for mortality, but no link was found between mortality and HbA1c, race or ethnicity, according to data from New York.
“We assumed that HbA1c would be predictive of poor outcomes, but that was not the case,” Alyson Myers, MD, director of inpatient diabetes at North Shore University Hospital and an associate professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, told Healio. “Unsurprisingly, hyperglycemia at admission was associated with worse outcomes, which has also been seen in persons without diabetes.”
Myers and colleagues analyzed health record data from people with type 2 diabetes who tested positive for COVID-19 and were admitted to any Northwell Health System hospital in New York from Jan. 1 to May 31, 2020. HbA1c was obtained from the closest date to the COVID-19 diagnosis. There were 3,846 people included in the analysis (59.6% men; median age, 68 years). About two-thirds of the study population was not white, with 27.1% listed as Black and 24.9% classified as multiracial or other.
The median age of those who died of COVID-19 was higher than those who were discharged (median age 72 years vs. 65 years; P < .0001), and there was a higher proportion of men in the COVID-19 mortality group compared with survivors (66.5% vs. 57.2%; P < .0001). Race, ethnicity and insurance status were not associated with mortality.
Of the study population, 73.2% had an HbA1c of less than 9%. There was no significant difference in COVID-19 mortality for those with an HbA1c above 9% compared with less than 9%. Those who died of COVID-19 had a higher point-of-care glucose measurement on admission compared with those who were discharged (195 mg/dL vs. 165 mg/dL; P < .0001), as well as a higher serum glucose level on admission (192 mg/dL vs. 171 mg/dL; P < .001). Those who died of COVID-19 were more likely to have chronic obstructive pulmonary disease (COPD; OR = 1.63; 95% CI, 1.3-2.06; 13.4% vs. 8%; P < .001), congestive heart failure (OR = 1.4; 95% CI, 1.15-1.71; 18.2% vs 13.1%; P < .001), coronary artery disease (OR = 1.43; 95% CI, 1.22-1.69; 32.7% vs. 24.6%; P < .001), chronic kidney disease (OR = 1.6; 95% CI, 1.32-1.94; 20.1% vs 13.1%; P < . 001) or myocardial infarction (OR = 1.69; 95% CI, 1.32-2.16; 11.75% vs. 7.5%; P < .001).
In multivariable regression analysis, age (HR = 0.76; 95% CI, 1.86-2.47), male sex (HR = 1.17; 95% CI, 1.04-1.34), mechanical ventilation (HR = 2.54; 95% CI, 2.2-2.93), COPD (HR = 1.23; 95% CI, 1-1.4) and MI (HR = 1.12; 95% CI, 0.91-1.39) were significant predictors for mortality.
“This study was conducted during the first surge, so the rates of mortality and mechanical ventilation were much higher,” Myers said. “With time, we have seen that high-flow oxygen, or bilevel positive airway pressure, can be used instead of mechanical ventilation. Also, the use of remdesivir (Veklury, Gilead Science) and Decadron (dexamethasone, Merck) has helped in improving outcomes. Based on these changes in care, the rates of mortality and intubation will likely be less during this second surge.”
The researchers were unable to include an analysis of diabetes medications in the study since it was a chart review, which Myers noted often contains inaccurate medications list. She said the impact of diabetes medications on COVID-19 outcomes is an area that researchers must continue to study.
For more information:
Alyson Myers, MD, can be reached at amyers@northwell.edu.
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