Department of Endocrinology and Metabolism, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan.
Department of Pulmonology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan.
J Diabetes Investig. 2022 Nov;13(11):1925-1933. doi: 10.1111/jdi.13869. Epub 2022 Jun 29.
AIMS/INTRODUCTION: To investigate overlooked diabetes in patients with coronavirus disease 2019 (COVID-19).
In total, 462 COVID-19 inpatients were included in this retrospective study. The presence of diabetes before COVID-19 admission, and the HbA1c and blood glucose levels at admission were examined.
Of the 462 patients, 116 had diabetes. Seventy-six patients had been diagnosed with diabetes before COVID-19 admission, and 40 patients were diagnosed for the first time. Of the patients with diabetes 72% required insulin. Patients with diabetes were significantly (P < 0.05) older, more likely to be male, heavier, and showed a lower eGFR. Patients with overlooked diabetes showed a lower HbA1c (average 7.1% vs 7.5%), a lower casual blood glucose (average 157 vs 179 mg/dL), and they used less insulin per day during hospitalization (average 16.0 units vs 34.5 units) than patients with previously diagnosed diabetes. Patients with overlooked diabetes tended to have more severe COVID-19 than those with pre-diagnosed diabetes. Multivariable logistic regression analyses showed that the increased odds ratios (ORs) of aggravation in all patients with COVID-19 were associated with age [OR 1.04], BMI [OR 1.05], and diabetes [OR 2.15]. The risk factors for aggravation in patients with COVID-19 and diabetes were age [OR 1.05] and HbA1c [OR 1.45].
Diabetes is a predictor of COVID-19 aggravation. Furthermore, in COVID-19 patients with diabetes, high HbA1c levels are a risk factor for severe COVID-19. A total of 8.7% of COVID-19 inpatients were diagnosed with diabetes after HbA1c was measured on admission. Therefore, it is important to measure HbA1c in COVID-19 patients.
目的/引言：调查 2019 年冠状病毒病（COVID-19）患者中被忽视的糖尿病。
本回顾性研究共纳入 462 例 COVID-19 住院患者。检查 COVID-19 入院前是否存在糖尿病，以及入院时的 HbA1c 和血糖水平。
462 例患者中，116 例患有糖尿病。76 例患者在 COVID-19 入院前被诊断患有糖尿病，40 例患者首次被诊断为糖尿病。患有糖尿病的患者中有 72%需要胰岛素。患有糖尿病的患者年龄明显较大（P < 0.05），更可能为男性，体重较重，且 eGFR 较低。被忽视的糖尿病患者的 HbA1c（平均 7.1%比 7.5%）较低，随机血糖（平均 157 比 179mg/dL）较低，住院期间每天使用的胰岛素也较少（平均 16.0 单位比 34.5 单位），与先前诊断为糖尿病的患者相比。被忽视的糖尿病患者的 COVID-19 病情往往比先前诊断为糖尿病的患者更严重。多变量逻辑回归分析显示，所有 COVID-19 患者病情加重的优势比（OR）与年龄[OR 1.04]、BMI[OR 1.05]和糖尿病[OR 2.15]相关。COVID-19 合并糖尿病患者病情加重的危险因素是年龄[OR 1.05]和 HbA1c[OR 1.45]。
糖尿病是 COVID-19 加重的预测因素。此外，在 COVID-19 合并糖尿病患者中，HbA1c 水平升高是 COVID-19 严重程度的危险因素。COVID-19 住院患者中，入院时测量 HbA1c 后有 8.7%被诊断为糖尿病。因此，在 COVID-19 患者中测量 HbA1c 很重要。
