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by Mike Watts

Hospital teams are being urged to focus on glycemic management among COVID-19 patients with diabetes and hyperglycemia after a research team found mortality rates are higher in people with diabetes.

An American team from the Emory University School of Medicine in Georgia say death rates are four times higher among people with diabetes and hyperglycemia who are infected with COVID-19.

They used health data taken from 1,122 people who were admitted to hospital with coronavirus between March 1 and April 6.

The researchers said 42% of all the participants in the study had diabetes or hyperglycemia, which means their blood sugar levels greater than 6.5%.

They also found that those with diabetes and hyperglycemia had an in-hospital death rate of 29%, compared with just 6% of those who did not have either condition.

Another pattern emerged among people who had not been diagnosed with diabetes. Having studied mortality rates, they found 42% of people without a prior diabetes diagnosis who were admitted to hospital and developed hyperglycemia while there, passed away.

Dr Bruce Bode, diabetes specialist at Atlanta Diabetes Associates and Adjunct Associate Professor of Medicine at Emory University School of Medicine, said: “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.

“This research confirms that diabetes is an important risk factor for dying from COVID-19. It also suggests that patients with acutely uncontrolled hyperglycemia – with or without a diabetes diagnosis – are dying at a higher rate than clinicians and hospitals may recognise.

“It is paramount that we treat hyperglycemia in COVID-19 patients as directed by national guidelines, with subcutaneous basal-bolus insulin in most non-critically ill patients, and with IV insulin in the critically ill.”

Dr Bode’s team also found that among the 493 people with diabetes who survived, their hospital stays were about 5.7 days longer among those who did not have the condition who stayed on average 4.3 days.

The study was supported by Glytec, a provider of insulin management software.

Dr Valerie Garrett, the company’s Executive Director of Quality Initiatives, said: “This initial analysis provides what we believe are new insights into the COVID-19 illness and suggests an opportunity exists for clinicians to save additional lives by intervening in acutely hyperglycemic patients to achieve guideline-directed glycemic targets.

“While glycemic care may not be top of mind in clinicians caring for patients with COVID-19, it appears to be a potentially very important aspect of care. We’re proud of Glytec’s ability to participate in important areas of research with our clinical partners and focus our analytics capability on revealing insights that can significantly improve patient care.”

Senior author of the research Dr David Klonoff, Medical Director of the Diabetes Research Institute, said their findings may have “wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes”.

The research has been published in the Journal of Diabetes Science and Technology.

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