Journal Article

Both high and low pre-infection glucose levels associated with increased risk for severe COVID-19: New insights from a population-based study

Bicher, Roee, Paltiel, Ora, Barenholz-Goultschin, Orit, Calderon-Margalit, Ronit, Safadi, Rifaat, Shafrir, Asher, Shauly-Aharonov, Michal, Stokar, Joshua

2021

Overview

Importance To assess the differential effects of pre-infection glucose levels on the risk for severe COVID-19 amongst patients with and without diabetes. National state-mandated HMO. All adult patients with a positive SARS-COV2 test between March-October 2020. 37,121 patients with a positive SARS-COV2 test were identified; 707 defined as severe (1.9%). Unadjusted risk factors for severe disease were age (OR = 1.1 for every year increase; 95% CI 1.09-1.11, p < 0.001), male gender (OR = 1.34, 95% CI 1.06-1.68, p = 0.012); BMI (OR = 1.02 for 1 kg/m.sup.2 increase, 95% CI 1.00-1.04, p = 0.025). Controlling for these factors, we found an association between pre-infection FBG and the risk of severe COVID-19, with a differential effect in patients with and without a diagnosis of diabetes. For patients without diabetes, elevated FBG in the pre-diabetes range (106-125 mg/dl) was associated with severe COVID-19 (OR 1.55 95% CI 1.04-2.26 p = 0.027). For patients with a diagnosis of diabetes, we found a J-shaped association between pre-infection glucose control and the risk for severe COVID-19 where the lowest risk for was for patients with FBG 106-125 mg/dl; the risk increased with higher pre-infection glucose levels but strikingly also for patients with a low pre-infection FBG (<100mg/dl) or HbA1C (<5.7%). Elevated pre-infection blood glucose is a risk factor for severe COVID-19 even in non-diabetics. For patients with a diagnosis of diabetes both high as well as low pre-infection glucose levels are risk factors for severe COVID-19. Further research is required to assess whether these associations are causal, but we believe these findings can already have clinical implications for COVID-19 risk assessment and stratification.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Biology and life sciences / Blood / Blood sugar / Body mass / Body mass index / Body size / Cardiovascular disease / Cardiovascular diseases / Complications and side effects / Coronary artery disease / Coronaviruses / COVID-19 / Diabetes / Diabetes mellitus / Diagnosis / Endocrinology / Gastroenterology / Gender / Glucose / Health aspects / Health insurance / Health maintenance organizations / Health risks / Health services / Heart diseases / Hemoglobin / HMOs / Hospitalization / Hospitals / Hyperglycemia / Hypertension / Infection / Infections / Ischemia / Laboratories / Medical diagnosis / Medicine / Medicine and Health Sciences / Patients / Physical Sciences / Population studies / Population-based studies / Public health / Risk analysis / Risk assessment / Risk factors / Risk management / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Standard deviation / Statistical analysis / Supervision / Variables / Viral diseases