40% of new-onset diabetes during COVID-19 remitted at 1 year
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Newly diagnosed diabetes was found in 4% of adults admitted to a U.S. hospital with COVID-19 early in the pandemic, and 40.6% of those patients returned to normoglycemia or prediabetes at 1 year, according to study data.
In a retrospective review of electronic health records of adults admitted to Massachusetts General Hospital in Boston with COVID-19, the percentage of adults with new-onset diabetes was lower than rates found in other studies, and only 13% of adults with any evidence of diabetes experienced hyperglycemia during hospitalization.
“A substantial number of the patients with newly diagnosed diabetes did not have regular access to medical care prior to COVID-19 admission and presented with very elevated HbA1c values, which suggest at least several months of hyperglycemia, rather than rapid onset of hyperglycemia at the time of COVID-19,” Sara Cromer, MD, clinical and research fellow in endocrinology at Massachusetts General Hospital, told Healio. “This suggests that many cases of ‘new-onset diabetes’ at the time of COVID-19 may represent a first presentation to medical care in a patient with preexisting but undiagnosed diabetes.”
Cromer and colleagues analyzed EHR data from all adults admitted to Massachusetts General Hospital with COVID-19 from March 1 to Sept. 27, 2020. Patients with no history or past clinical notes reporting a diagnosis of diabetes, no HbA1c values above 6.5%, no random glucose values higher than 200 mg/dL and having never taken a non-metformin diabetes medication were defined as having newly diagnosed diabetes. Diabetes type, glycemic trajectory and diabetes persistence or regression were obtained during follow-up through July 1, 2021.
The findings were published in the Journal of Diabetes and Its Complications.
Few patients newly diagnosed with diabetes
Of 1,902 people hospitalized with COVID-19, 31.2% had diabetes. Newly diagnosed diabetes was observed in 4% of all hospitalized patients and 13% of those with diabetes. Of those with newly diagnosed diabetes, 42.9% had some evidence of prediabetes before admission.
In multivariable analysis adjusted for age, sex, race and ethnicity, and BMI, patients with newly diagnosed diabetes had lower insulin requirements during the first 3 days of hospitalization (beta = –12.67 U; 95% CI, –20.53 to –4.82), a longer hospitalization duration (beta = 8.69 days; 95% CI, 4.53-13.04) and were more likely to be admitted to the ICU (adjusted OR = 4.42; 95% CI, 2.56-7.9) compared with those with preexisting diabetes.
Lower glucose levels post-hospitalization
Of those with newly diagnosed diabetes, 10 died during their initial COVID-19 hospitalization, and three were lost to follow-up. Of the remaining 64 adults with newly diagnosed diabetes, 56.3% continued to have evidence of diabetes after a median of 323 days of follow-up and 40.6% regressed to normoglycemia or prediabetes. Of those with evidence of diabetes at follow-up, 44.4% had diet-controlled diabetes with a median HbA1c of 6.4%, 41.7% used noninsulin medications with a median HbA1c of 6.2%, and 13.9% required insulin with a median HbA1c of 8.3%.
“Almost half with newly diagnosed diabetes experienced regression of hyperglycemia either to the normal range or the prediabetic range,” Cromer said. “This suggests that the very high blood sugar seen in these patients during admission for COVID-19 may represent stress hyperglycemia rather than a permanent change in their physiology. Among those patients who continued to have evidence of diabetes upon follow-up, the majority were diagnosed with type 2 diabetes and managed without insulin, suggesting that permanent beta-cell injury or death is not a major driver of newly diagnosed diabetes at the time of COVID-19 admission.”
In 33 adults with newly diagnosed diabetes who had evidence of preexisting diabetes, 28 were discharged from the hospital. Of those, 64% had persistent diabetes, 25% regressed to normoglycemia, and 11% continued to have prediabetes at follow-up.
When presented with a patient with COVID-19 and evidence of diabetes, Cromer said, it is crucial for providers to consider their medical history when devising a treatment plan.
“Among individuals diagnosed with diabetes at the time of COVID-19 admission, it is important to consider whether their diabetes is truly new-onset or could be preexisting but only newly recognized,” Cromer said. “If the latter, it will be important to consider limited access to health care and social determinants of health when designing the patient’s discharge plan. Patients with newly diagnosed diabetes may experience more severe COVID-19 and should be closely monitored after their infection is recognized. Finally, patients with suspected new diabetes at the time of COVID-19 may experience improving blood sugars following resolution of their acute illness, and these patients should receive close follow-up, especially if they are discharged on medicines like insulin, which may require down-titration for safety as hyperglycemia resolves.”
For more information:
Sara Cromer, MD, can be reached at scromer@mgh.harvard.edu.
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