Is elevated blood glucose at admission associated with poor outcomes in hospitalized COVID-19 patients?

Comparative Analysis of COVID-19 Outcomes in Type 1 and Type 2 Diabetes: A Three-Year Retrospective Study

Background and Objectives: This comprehensive retrospective study assesses COVID-19 outcomes in type 1 (T1D) and type 2 diabetes (T2D) patients across three years, focusing on how these outcomes varied with the evolving pandemic and changes in diabetes management. The study aims to determine if COVID-19 outcomes, including severity, intensive care unit (ICU) admission rates, duration of hospitalization, and mortality, are significantly different between these diabetes subtypes. Materials and Methods: The study analyzed data from patients admitted to the Victor Babes Hospital for Infectious Diseases and Pulmonology with confirmed COVID-19 and pre-existing diabetes, from the years 2020, 2021, and 2022. Results: Among 486 patients (200 without diabetes, 62 with T1D, 224 with T2D), T2D patients showed notably higher severity, with 33.5% experiencing severe cases, compared to 25.8% in T1D. Mortality rates were 11.6% in T2D and 8.1% in T1D. T2D patients had longer hospital stays (11.6 ± 7.0 days) compared to T1D (9.1 ± 5.8 days) and were more likely to require ICU admission (OR: 2.24) and mechanical ventilation (OR: 2.46). Hyperglycemia at admission was significantly higher in the diabetes groups, particularly in T2D (178.3 ± 34.7 mg/dL) compared to T1D (164.8 ± 39.6 mg/dL). Conclusions: The study reveals a discernible difference in COVID-19 outcomes between T1D and T2D, with T2D patients having longer hospital admissions, mechanical ventilation necessities, and mortality risks.

COVID-19 Mortality in the Delta Wave in India: A Hospital-Based Study From Ramanagara District, Karnataka

INTRODUCTION

Coronavirus 19 (COVID-19) disease spread rapidly over the world since its inception in December 2019 in Wuhan, China. India too was crippled by the burden of high caseloads and deaths. The first death caused by COVID-19 in Karnataka was reported on March 13, 2020. There is a plethora of information on the descriptive statistics, epidemiology, and management of COVID-19 cases. However, there has not been an in-depth and extensive exploration of COVID-19 mortality data in terms of published research from India. The study area was a 300 bedded tertiary care center in Ramnagara district, Karnataka. During the second wave, 150 beds were dedicated to COVID-19 cases referred from government centers. This study was carried out to assess the in-hospital mortality at this institute during the second wave. The expected outcome of this study was to shed light on co-morbidities associated with mortality, the age and sex distribution in mortality, and any other significant factors influencing mortality due to COVID-19.

METHODOLOGY

A hospital-based, retrospective, and observational-analytical study was carried out during April-August 2021, the second wave of COVID-19. The data included all deaths recorded in-hospital during the dedicated COVID-19 referral center status. Data were collected from case sheets and mortality audit forms that included basic demographics, symptoms, co-morbidities, admission pathway, transfer to ICU, oxygen therapy, ventilator requirement, duration of hospitalization, laboratory profile, and management modalities prior to death. Data were compiled into Microsoft Excel and were analyzed with JASP software (open source). Data were interpreted in terms of frequencies, averages with standard deviation, and bivariate and multivariate analysis.

RESULTS

 We analyzed mortality audits of 91 adult patients and one neonate. The male-to-female ratio was 1.67:1 (> 60% male), with an average age of 53.4 years (standard deviation 15.4 years). Most of the patients fell in the age range of 36 to 65 years (65%). The average duration was 5.6 days (range 0-35 days). The most common symptom was fever (84, 92.31%), followed by breathlessness (77, 84.62%) and fatigue (65, 71.43%). Only 10 had a positive contact history and only one patient reported travel to a containment zone. The source of infection was indeterminate in the majority of cases. Diabetes mellitus and hypertension were the commonest associated comorbidities. Almost three-quarters of the patients were tachypneic at admission and nearly 90% had low levels which included 43 patients with critically low SpO2. The inflammatory indicators, such as WBC count, CRP, and d-dimer, were raised in many patients (WBC count raised in 40% and d-dimer, CRP raised in > 50% of cases). A striking 83% of the patients had hyperglycemia. The most common immediate cause of death pertained to the respiratory system (ARDS, refractory hypoxia, respiratory) in more than half of the patients.

CONCLUSION

 This study reported the clinical and laboratory characteristics of 91 adult COVID-19 mortality cases at a teaching hospital at the peak of the Delta wave in Karnataka. While inflammatory indicators such as WBC count, CRP, and d-dimer were raised in many patients, our most remarkable finding was the high frequency of hyperglycemia. The findings of our study would contribute to enhancing the understanding of the clinical correlates and progression of COVID-19.