APRIL 17, 2020

Diabetes patients at four times greater risk of death from COVID-19

Diabetic and hyperglycemic patients who contract COVID-19 are more than four times as likely to have complications that result in either death or longer hospital stays than their peers without those co-morbidities, according to a new study.

An analysis of more than 1,100 COVID-19 patients hospitalized in 88 facilities between March 1 and April 6 found 39% had either diabetes or uncontrolled hyperglycemia. Approximately 29% of those patients died in the hospital from COVID-19 compared to 6% of patients without those underlying health conditions. Surprisingly, 42% of patients who had no history of being diabetic prior to be admitted to the hospital but were diagnosed with hyperglycemia during their stay died from COVID-19.

The results were published Friday in the Journal of Diabetes Science and Technology.

"The coronavirus outbreak has stretched our hospitals and health systems to a point we've never experienced before, so it's understandable that glycemic management may not have been a major point of focus thus far," said study co-author Dr. Bruce Bode, an Emory University School of Medicine adjunct associate professor and co-founder of insulin management software firm, Glytec, which conducted the study.

Researchers also reviewed patients who were ultimately discharged after their COVID-19 hospital stay. Those who were diabetic or had uncontrolled hyperglycemia had an average length of stay of 5.7 days compared to 4.3 days among non-diabetic patients and those without uncontrolled hyperglycemia.

Diabetic and hyperglycemic patients spent an average of 38% of their hospital days with an average blood-glucose level above the American Diabetes Association's recommended upper limit of 180 milligrams per deciliter (mg/dl) for most hospital inpatients.

The study is the latest evidence to highlight how those with underlying health conditions are at increased risk for developing severe complications from COVID-19. Approximately 90% of hospitalized patients identified with having COVID-19 had one or more chronic health conditions, including obesity, hypertension, chronic lung disease, cardiovascular disease and diabetes, according to a Centers for Disease Control and Prevention report published Wednesday.

But the study's findings also raise concerns about some of the challenges that healthcare providers are facing in trying to manage chronic health conditions during a pandemic when resources are limited.

Dr. Robert Eckel, professor of medicine in the division of endocrinology, metabolism and diabetes at the University of Colorado Anschutz Medical Campus and president of medicine and science for the American Diabetes Association, said the current outbreak has made managing diabetes in the hospital more difficult because proper tracking of blood glucose levels can often require clinical staff to take frequent blood samples of patients. In a pandemic, such care would likely cause providers to rapidly use up their already limited supplies of personal protective equipment.

Eckel suggested hospitals use constant glucose monitor devices as opposed to more traditional blood glucose meters, which require healthcare personnel to get frequent blood samples on finger sticks.

"Those hospitals without CGM, their staff need to be trained and CGM units obtained," Eckel said. "Hospital staff can then be spared frequent finger sticks."

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