Abstract and Introduction
Abstract
Context: In patients with severe acute respiratory syndrome coronavirus type 2 infection, diabetes is associated with poor COVID-19 prognosis. However, case detection strategy is divergent and reported prevalence varies from 5% to 35%.
Objective: We examined how far the choice of screening tools affects the detection rate of dysglycemia and in consequence the estimation of diagnosis-associated risk for moderate (mo) or severe (s) COVID-19.
Methods: Non–intensive care unit inpatients with COVID-19 were screened systematically at admission for diabetes (D) and prediabetes (PreD) by glycated hemoglobin A1c (HbA1c) (A), random blood glucose (B), and known history (C) from November 1, 2020 to March 8, 2021. Dysglycemia rate and effect on COVID-19 outcome were analyzed in 2 screening strategies (ABC vs BC).
Results: A total of 578 of 601 (96.2%) of admitted patients were screened and analyzed. In ABC, prevalence of D and PreD was 38.2% and 37.5%, respectively. D was significantly associated with an increased risk for more severe COVID-19 (adjusted odds ratio [aOR] [moCOVID-19]: 2.27, 95% CI, 1.16–4.46 and aOR [sCOVID-19]: 3.26, 95% CI, 1.56–6.38). Patients with PreD also presented more often with more severe COVID-19 than those with normoglycemia (aOR [moCOVID-19]: 1.76, 95% CI, 1.04–2.97 and aOR [sCOVID-19]: 2.41, 95% CI, 1.37–4.23). Screening with BC failed to identify only 96% of PreD (206/217) and 26.2% of D diagnosis (58/221) and missed associations of dysglycemia and COVID-19 severity.
Conclusion: Pandemic conditions may hamper dysglycemia detection rate and in consequence the awareness of individual patient risk for COVID-19 severity. A systematic diabetes screening including HbA1c reduces underdiagnosis of previously unknown or new-onset dysglycemia, and enhances the quality of risk estimation and access of patients at risk to a diabetes-specific intervention.
Introduction
In patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), diabetes mellitus (D) is associated with a poor prognosis for an adverse outcome of COVID-19 with a nearly 3-fold increased risk of a severe course, need for intensive care unit (ICU) treatment, and mortality.[1–3] The degree of hyperglycemia modulates COVID-19 severity. In patients with D, a higher glycated hemoglobin A1c (HbA1c) is associated with increased mortality risk.[2,4] Noteworthy, a higher risk for adverse COVID-19 outcome is also reported for mild forms of dysglycemia such as prediabetes (PreD).[2,4]
The prevalence of dysglycemia is underreported in Germany, with 1 of 5 D-affected adults in the general population and 1 of 3 inpatient D cases being undiagnosed.[5,6] Furthermore, new-onset D by SARS-CoV-2-infection of pancreatic β cells has been discussed[7] and may also affect future diabetes prevalence in certain populations.
Studies with a divergent choice of case detection strategy report a largely varying prevalence of dysglycemia in COVID-19 patients ranging from 2.4% to 23.9% for PreD and 4.7% to 35.5% for D.[1,8] Surprisingly, prevalence in the examined COVID-19 cohorts was partially even lower than in the general population.[9] Case detection is the critical starting point for risk estimation analyses and treatment initiation. We hypothesized that in hospitalized patients, systematic screening for diabetes enhances case detection rate affects the estimation of COVID-19 severity and may hence improve access to D-specific management. To evaluate the influence of chosen diagnostic tools on D and PreD prevalence and the associated risk for more severe COVID-19 course, we compared 2 different dysglycemia screening scenarios in a cohort of non-ICU patients with COVID-19 treated at one of the largest COVID-19 university referral centers in Germany.
J Clin Endocrinol Metab. 2023;108(3):697-705. © 2023 Endocrine Society
