HbA1c levels linked to hospitalization risk in patients with type 2 diabetes, COVID-19
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For patients with type 2 diabetes and COVID-19, the risk for hospitalization increased with incrementally higher HbA1c levels, according to results of a large, multicenter cohort study.
“Risk of death and invasive ventilation also increased but plateaued at different levels of glycemic control,” Rachel Wong, MD, of Stony Brook University, and colleagues wrote.
The retrospective study featured observational data from the National COVID Cohort Collaborative, a longitudinal, multicenter U.S. cohort of patients with COVID-19. Patients were aged at least 18 years and had type 2 diabetes and COVID-19 infection confirmed by laboratory testing or diagnosis code.
Thirty-day mortality after the date of COVID-19 diagnosis served as the primary outcome measure. Secondary outcomes were the need for invasive ventilation or extracorporeal membrane oxygenation (ECMO), hospitalization within 7 days before or 30 days after COVID-19 diagnosis, and length of stay for hospitalized patients.
Overall, 39,616 adults (50.9% women; mean age, 62.1 years) were included in the study.
Researchers observed the following rates: mortality, 5.7%; invasive ventilation or ECMO, 7%; and hospitalization, 49%. The mean length of stay was 11.7 days, and mean HbA1c was 7.6%.
Results indicated that the risk for hospitalization increased with incrementally higher HbA1c levels, plateauing at HbA1c greater than 8%. Similarly, the odds of invasive ventilation or ECMO increased incrementally with each HbA1c category between 6% and 7%, plateauing with HbA1c greater than 9%.
In addition, no significant difference in length of stay across HbA1c levels was found.
The researchers highlighted several limitations with the study, including the inability to both delineate the duration of diabetes in the cohort and assess COVID-19specific mortality.
“Despite these limitations, this study represents the largest multicenter U.S. cohort study of HbA1c and COVID-19 outcomes to date,” the researchers wrote. “We report that risk of hospitalization increased with incrementally higher HbA1c levels. Risk of death and invasive ventilation also increased relative to those with good glycemic control, but this effect plateaued at different levels of glycemia.”
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