Characteristics and Clinical Outcomes of COVID-19 Patients with Hyperglycemia: Retrospective Cohort Study from a COVID-19 Referral Hospital, Bandung, Indonesia

Hikmat Permana, Annisa Ikhsanawati, Evan Susandi, Nanny Natalia Mulyani Soetedjo, Bachti Alisjahbana

Abstract


Background: COVID-19 often causes severe complications in patients with metabolic disorders such as diabetes mellitus. Conversely, inflammation caused by infection may also trigger insulin resistance, resulting in hyperglycemia and is related to the disease severity. This study aimed to describe the characteristics and clinical outcomes of COVID-19 patients with hyperglycemia at one of the COVID-19 referral hospitals in Bandung, Indonesia.

Methods: This retrospective cohort study used secondary data from medical records of COVID-19 patients admitted to Dr. Hasan Sadikin General Hospital Bandung, Indonesia from March 2020 to March 2021. This study included all patients with confirmed COVID-19, aged >18 years, and had at least one blood glucose test at admission. Patients were grouped based on three possible types of hyperglycemia, namely diabetes mellitus, reactive hyperglycemia, and steroid-induced hyperglycemia; then their characteristics and disease outcomes were compared.

Results: This study identified 1,114 patients’ medical records and included 1,013 data in the analysis. Hyperglycemia occurred in 45.1% of COVID-19 patients. The most common hyperglycemia types were diabetes mellitus (55.7%), reactive hyperglycemia (37.4%), and steroid-induced hyperglycemia (7%). The steroid-induced hyperglycemia group had similar characteristics as the diabetes group. The reactive hyperglycemia group exhibited a metabolic syndrome pattern resembling pre-diabetic conditions. The highest rates of severe disease and mortality were seen in the steroid-induced hyperglycemia group, followed by the diabetes group.

Conclusions: There is an elevated prevalence of hyperglycemia in COVID-19 patients with diabetes. The steroid-induced hyperglycemia group has the most unfavorable outcomes. These observations emphasize the importance of identifying hyperglycemic conditions to improve management and outcomes.


Keywords


COVID-19, characteristics, diabetes, hyperglycemia

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References


  1. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14(3):211–2.
  2. Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142.
  3. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;36(7):e3319.
  4. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ. 2020;27(5):1451–4.
  5. Abdi A, Jalilian M, Sarbarzeh PA, Vlaisavljevic Z. Diabetes and COVID-19: a systematic review on the current evidence. Diabetes Res Clin Pract. 2020;166:108347.
  6. Graves DT, Kayal RA. Diabetic complications and dysregulated innate immunity. Front Biosci. 2008;13:1227–39.
  7. de Candia P, Prattichizzo F, Garavelli S, De Rosa V, Galgani M, Di Rella F, et al. Type 2 diabetes: how much of an autoimmune disease? Front Endocrinol (Lausanne). 2019;10:451.
  8. Clain J, Ramar K, Surani SR. Glucose control in critical care. World J Diabetes. 2015;6(9):1082–91.
  9. WHO, International Diabetes Federation, editors. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: WHO; 2006.
  10. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2020;44(Suppl 1):S15–S33.
  11. Soelistijo SA, Lindarti D, Decroli E, Permana H, Sucipto KW, Kusnadi Y, et al. Pedoman pengelolaan diabetes mellitus tipe 2 dewasa di Indonesia 2019. Jakarta: PB PERKENI; 2019.
  12. WHO. Clinical management of COVID-19: interim guidance, 27 May 2020. Geneva: World Health Organization; 2020.
  13. Saand AR, Flores M, Kewan T, Alqaisi S, Alwakeel M, Griffiths L, et al. Does inpatient hyperglycemia predict a worse outcome in COVID‐19 intensive care unit patients? J Diabetes. 2021;13(3):253–60.
  14. Sardu C, D’Onofrio N, Balestrieri ML, Barbieri M, Rizzo MR, Messina V, et al. Outcomes in patients with hyperglycemia affected by COVID-19: can we do more on glycemic control? Diabetes Care. 2020;43(7):1408–15.
  15. Sharma J, Chittawar S, Maniram RS, Dubey T, Singh A. Clinical and epidemiological study of stress hyperglycemia among medical intensive care unit patients in Central India. Indian J Endocrinol Metab. 2017;21(1):137–41.
  16. Baker L, Maley JH, Arévalo A, DeMichele F, Mateo-Collado R, Finkelstein S, et al. Real-world characterization of blood glucose control and insulin use in the intensive care unit. Sci Rep. 2020;10(1):10718.
  17. Gao M, Piernas C, Astbury NM, Hippisley-Cox J, O’Rahilly S, Aveyard P, et al. Associations between body-mass index and COVID-19 severity in 6.9 million people in England: a prospective, community-based, cohort study. Lancet Diabetes Endocrinol. 2021;9(6):350–9.
  18. Gianchandani R, Esfandiari NH, Ang L, Iyengar J, Knotts S, Choksi P, et al. Managing hyperglycemia in the COVID-19 inflammatory storm. Diabetes. 2020;69(10):2048–53.
  19. He S, Liu W, Jiang M, Huang P, Xiang Z, Deng D, et al. Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: a multi-center study. PLoS One. 2021;16(4):e0249668.
  20. Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID-19 pandemic. J Med Virol. 2020;92(7):770–5.
  21. Pittet LA, Hall-Stoodley L, Rutkowski MR, Harmsen AG. Influenza virus infection decreases tracheal mucociliary velocity and clearance of Streptococcus pneumoniae. Am J Respir Cell Mol Biol. 2010;42(4):450–60.
  22. Smith CM, Kulkarni H, Radhakrishnan P, Rutman A, Bankart MJ, Williams G, et al. Ciliary dyskinesia is an early feature of respiratory syncytial virus infection. Eur Respir J. 2014;43(2):485–96.
  23. Piscoya A, Ng-Sueng LF, Parra del Riego A, Cerna-Viacava R, Pasupuleti V, Roman YM, et al. Efficacy and harms of remdesivir for the treatment of COVID-19: a systematic review and meta-analysis. PLoS One. 2020;15(12):e0243705.
  24. Umpierrez GE, Pasquel FJ. Management of inpatient hyperglycemia and diabetes in older adults. Diabetes Care. 2017;40(4):509–17.
  25. Zheng M, Wang X, Guo H, Fan Y, Song Z, Lu Z, et al. The cytokine profiles and immune response are increased in COVID-19 patients with type 2 diabetes mellitus. J Diabetes Res. 2021;2021:9526701.
  26. Qureshi QH, Ashraf T, Rehman K, Khosa MK, Akash MSH. Therapeutic interventions of remdesivir in diabetic and nondiabetic COVID‐19 patients: a prospective observational study conducted on Pakistani population. J Med Virol. 2021;93(12):6732–6.
  27. Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol. 2010;47(3):193–9.
  28. Yang Y, Cai Z, Zhang J. Hyperglycemia at admission is a strong predictor of mortality and severe/critical complications in COVID-19 patients: a meta-analysis. Biosci Rep. 2021;41(2):BSR20203584.
  29. Klonoff DC, Messler J, Valk T, Jagannathan R, Pasquel FJ, Umpierrez GE. Clinical trials of COVID-19 therapies should account for diabetes and hyperglycemia. J Diabetes Sci Technol. 2021;15(5):1181–7.
  30. Zhang Y, Li H, Zhang J, Cao Y, Zhao X, Yu N, et al. The clinical characteristics and outcomes of patients with diabetes and secondary hyperglycaemia with coronavirus disease 2019: A single-centre, retrospective, observational study in Wuhan. Diabetes Obes Metab. 2020;22(8):1443–54.




DOI: https://doi.org/10.15850/amj.v10n4.3111

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