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Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes.
Cell Metab. 2020 Jun 02; 31(6):1068-1077.e3.CM

Abstract

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.

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Authors+Show Affiliations

Zhu L
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
She ZG
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Cheng X
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Qin JJ
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Zhang XJ
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Cai J
Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
Lei F
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Wang H
Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.
Xie J
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China.
Wang W
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Li H
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Zhang P
Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.
Song X
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Chen X
Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.
Xiang M
Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430072, China.
Zhang C
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Bai L
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Xiang D
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Chen MM
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Liu Y
Institute of Model Animal, Wuhan University, Wuhan 430072, China.
Yan Y
Wuhan Seventh Hospital, Wuhan 430072, China.
Liu M
The Ninth Hospital of Wuhan City, Wuhan 430072, China.
Mao W
Department of General Surgery, Huanggang Central Hospital, Huanggang 438000, China.
Zou J
Department of Pulmonary and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430072, China.
Liu L
Department of General Surgery, Ezhou Central Hospital, Ezhou 436000, China.
Chen G
Department of Neurology, Wuhan First Hospital/Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan 430072, China.
Luo P
Department of Urology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China.
Xiao B
Department of Stomatology, Xiantao First People's Hospital, Xiantao 433000, China.
Zhang C
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.
Zhang Z
The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.
Lu Z
Department of Neurology, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000, China.
Wang J
Department of Orthopedics, The First People's Hospital of Jingmen affiliated to Hubei Minzu University, Jingmen 448000 China.
Lu H
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Changjiang University, Jingzhou 434000, China.
Xia X
Department of Hepatobiliary Surgery, Jingzhou Central Hospital, Jingzhou 434000, China.
Wang D
Department of Hepatobiliary and Pancreatic Surgery, Xianning Central Hospital, Xianning 437000, China.
Liao X
Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China.
Peng G
Department of Hepatobiliary and Pancreatic Surgery, Suizhou Central Hospital Affiliated to Hubei Medical College, Suizhou 441300, China.
Ye P
Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430072, China.
Yang J
Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University and Yichang Central People's Hospital and Institute of Cardiovascular Diseases, China Three Gorges University, Yichang 443000, China.
Yuan Y
Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430072, China.
Huang X
Department of Gastroenterology, Wuhan Third Hospital and Tongren Hospital of Wuhan University, Wuhan 430072, China. Electronic address: hxd19681031@whu.edu.cn.
Guo J
Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine & Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China and Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou 510006, China. Electronic address: guoj@gdpu.edu.cn.
Zhang BH
Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan 430072, China. Electronic address: rm001985@whu.edu.cn.
Li H
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 410013, China; Institute of Model Animal, Wuhan University, Wuhan 430072, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430072, China; Basic Medical School, Wuhan University, Wuhan 430072, China. Electronic address: lihl@whu.edu.cn.

MeSH

AgedBetacoronavirusBlood GlucoseCOVID-19Coronavirus InfectionsDiabetes Mellitus, Type 2Disease SusceptibilityFemaleGlycemic IndexHospitalizationHumansHyperglycemiaHypoglycemic AgentsLongitudinal StudiesMaleMiddle AgedMultiple Organ FailurePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32369736

Clinical Trial Links

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The Clinical Manifestations of the Severe Acute Respiratory Syndrome, Coronavirus 2( SARS-Cov-2 ); Not Only Pulmonary
FEnofibRate as a Metabolic INtervention for COVID-19

Citation

Zhu, Lihua, et al. "Association of Blood Glucose Control and Outcomes in Patients With COVID-19 and Pre-existing Type 2 Diabetes." Cell Metabolism, vol. 31, no. 6, 2020, pp. 1068-1077.e3.
Zhu L, She ZG, Cheng X, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020;31(6):1068-1077.e3.
Zhu, L., She, Z. G., Cheng, X., Qin, J. J., Zhang, X. J., Cai, J., Lei, F., Wang, H., Xie, J., Wang, W., Li, H., Zhang, P., Song, X., Chen, X., Xiang, M., Zhang, C., Bai, L., Xiang, D., Chen, M. M., ... Li, H. (2020). Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism, 31(6), 1068-e3. https://doi.org/10.1016/j.cmet.2020.04.021
Zhu L, et al. Association of Blood Glucose Control and Outcomes in Patients With COVID-19 and Pre-existing Type 2 Diabetes. Cell Metab. 2020 Jun 2;31(6):1068-1077.e3. PubMed PMID: 32369736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. AU - Zhu,Lihua, AU - She,Zhi-Gang, AU - Cheng,Xu, AU - Qin,Juan-Juan, AU - Zhang,Xiao-Jing, AU - Cai,Jingjing, AU - Lei,Fang, AU - Wang,Haitao, AU - Xie,Jing, AU - Wang,Wenxin, AU - Li,Haomiao, AU - Zhang,Peng, AU - Song,Xiaohui, AU - Chen,Xi, AU - Xiang,Mei, AU - Zhang,Chaozheng, AU - Bai,Liangjie, AU - Xiang,Da, AU - Chen,Ming-Ming, AU - Liu,Yanqiong, AU - Yan,Youqin, AU - Liu,Mingyu, AU - Mao,Weiming, AU - Zou,Jinjing, AU - Liu,Liming, AU - Chen,Guohua, AU - Luo,Pengcheng, AU - Xiao,Bing, AU - Zhang,Changjiang, AU - Zhang,Zixiong, AU - Lu,Zhigang, AU - Wang,Junhai, AU - Lu,Haofeng, AU - Xia,Xigang, AU - Wang,Daihong, AU - Liao,Xiaofeng, AU - Peng,Gang, AU - Ye,Ping, AU - Yang,Jun, AU - Yuan,Yufeng, AU - Huang,Xiaodong, AU - Guo,Jiao, AU - Zhang,Bing-Hong, AU - Li,Hongliang, Y1 - 2020/05/01/ PY - 2020/4/20/received PY - 2020/4/26/revised PY - 2020/4/28/accepted PY - 2020/5/6/pubmed PY - 2020/6/17/medline PY - 2020/5/6/entrez PY - 2020/5/1/pmc-release KW - COVID-19 KW - SARS-CoV-2 KW - blood glucose control KW - diabetes mellitus KW - mortality SP - 1068 EP - 1077.e3 JF - Cell metabolism JO - Cell Metab VL - 31 IS - 6 N2 - Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D. SN - 1932-7420 UR - https://www.unboundmedicine.com/medline/citation/32369736/full_citation DB - PRIME DP - Unbound Medicine ER -
High [↓993 ↑34]

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