Effect of Baseline HbA1c and Inpatient Glycemic Control on Mortality and Organ Dysfunction among Patients with Diabetes Mellitus Hospitalized for COVID-19: A Multicenter Retrospective Cohort Study
DOI:
https://doi.org/10.15605/jafes.041.01.5089Keywords:
COVID-19, diabetes mellitus, glycemic control, mortalityAbstract
Background. Individuals with diabetes mellitus (DM) show increased susceptibility to COVID-19 infection with higher risk for severe disease and mortality.
Objectives. We investigated whether glycemic-related factors may affect the outcomes of patients with DM hospitalized due to COVID-19.
Methodology. This is a multicenter retrospective cohort study under the initiative of the Philippine College of Endocrinology, Diabetes, and Metabolism involving eight training hospitals in the Philippines from January 2021 to January 2022. Patients with DM hospitalized due to COVID-19 were included. Multiple binary logistic regression was done to determine whether baseline glycemic control based on glycosylated hemoglobin (HbA1c) and inpatient glycemic control based on capillary blood glucose are associated with composite poor clinical outcome of mortality and end-organ dysfunction.
Results. Among 1,093 patients, 54% had HbA1c >7%. Both poor baseline glycemic (AOR 1.41, p= 0.017) and poor inpatient glycemic control (AOR 2.6, p<0.001) were associated with composite poor clinical outcome of mortality and end-organ dysfunction. HbA1c >7% increased the odds of poor inpatient control (OR = 3.10, 95% CI: 2.32–4.17, p < 0.001), even after adjusting for steroid use.
Conclusion. Poor inpatient glycemic control has greater effect on mortality and end-organ dysfunction than baseline glycemic control. However, baseline HbA1c >7% is predictive of poor inpatient glycemic control. Measures to optimize glycemic control both in the long term and during hospitalization will improve clinical outcomes for DM patients with COVID-19.
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