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Largest Study to Date Links Glucose Control to COVID-19 Outcomes

What your doctor is reading on Medscape.com:

MAY 14, 2020 — The strong link between glucose control and COVID-19 outcomes has been re-affirmed in the largest study thus far of hospitalized patients with pre-existing type 2 diabetes.

The retrospective, multicenter study, from 7337 hospitalized patients with COVID-19, was published online in Cell Metabolism by Lihua Zhu, Renmin Hospital of Wuhan University, China, and colleagues.

The study finds that, while the presence of type 2 diabetes per se is a risk factor for worse COVID-19 outcomes, better glycemic control among those with pre-existing type 2 diabetes appears to be associated with significant reductions in adverse outcomes and death.

“We were surprised to see such favorable outcomes in the well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes,” said senior author Hongliang Li, also of Renmin Hospital, in a statement.

“Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes,” Li added.

Asked to comment on the findings, David Klonoff MD, cautioned that the way in which the “well-controlled” diabetes group was distinguished from the “poorly controlled” one in this study used a “non-standard method for distinguishing these groups based on variability.”

So “there was a great deal of overlap between the two groups,” he observed.

Klonoff is medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center, San Mateo, California. 

Diabetes Itself Was Associated With Worse COVID-19 Outcomes

Of the 7337 participants with confirmed COVID-19 in the Chinese study, 13% (952) had pre-existing type 2 diabetes while the other 6385 did not have diabetes.

Median ages were 62 years for those with and 53 years for those without diabetes. As has been reported several times since the pandemic began, the presence of diabetes was associated with a worse COVID-19 prognosis.

Those with pre-existing diabetes received significantly more antibiotics, antifungals, systemic corticosteroids, immunoglobulin, antihypertensive drugs, and vasoactive drugs than did those without diabetes. They were also more likely to receive oxygen inhalation (76.9% vs 61.2%), non-invasive ventilation (10.2% vs 3.9%), and invasive ventilation (3.6% vs 0.7%).

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