Endocrine Abstracts

Introduction

SARS-CoV2 infection can worsen glycemic control regardless of history of Diabetes mellitus (DM) and may precipitate new-onset diabetes (NOD). DM is also a risk factor for a greater severity of COVID-19. At-admission hyperglycemia (AH) is a known predictor of critical illness in other diseases.

Aims

Assess the impact of AH, regardless of the presence of DM, on the severity of COVID-19 inpatients.

Methods

Retrospective observational study on COVID-19 patients admitted to the IMFU from 3rd March to 31^st October 2020, in order to assess associations between AH and severity outcomes: respiratory support (oxygen therapy or invasive mechanical ventilation – IMV), admission to Intensive Care Unit (ICU), and mortality in inpatients with and without DM.

Results

In 374 patients, 209 (55.9%) were males. The average age was 68 ± 19.3 years. DM was present in 105 patients (28.1%) with a HbA1c of 7.2% [IQR 6.2–8.3]. NOD was diagnosed in 15 patients (4%) with a HbA1c of 7.6% [IQR 6.8–11.1] with 2 of them presenting with diabetic ketoacidosis (DK). Blood glucose at admission was evaluated in 360 patients. Considering diabetic patients with AH (N = 68; 64.8%) there was a statistically significant correlation with COVID-19 severity (P = 0.03), IMV (P = 0.008) and ICU admission (P = 0.026) but not with oxygen therapy or mortality. In diabetic patients without AH (N = 33; 31.4%), there wasn’t a statistically significant correlation with any of severity outcomes. In nondiabetic patients with AH (N = 51; 17.5%) there was a statistically significant correlation with oxygen therapy (P = 0.001); IMV (P = 0.01) and ICU admission (P = 0.03) but not with mortality (P = NS). All 15 NOD patients had AH and 12 had severe/critical COVID-19, needing oxygen therapy. ICU admission occurred in one third of NOD patients (N = 5): 4 of them being submitted to IMV; the other admitted due to DK. Three NOD patients died. In NOD patients, no statistical significance was found between AH and severity outcomes (probably due to the small size of this group of patients).

Conclusion

The results support previous data regarding the impact of at-admission hyperglycemia on severity outcomes, and suggests a strong effect on short and long-term prognosis of COVID-19 inpatients, both with and without diabetes. We reinforce the importance to assess at-admission glycemia in all patients admitted with COVID-19.