Einstein-Mount Sinai Diabetes Research Center, The Norman Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Diabetes Care. 2022 Nov 1;45(11):2683-2688. doi: 10.2337/dc22-0708.
Diabetes and the outpatient diabetes treatment regimen have been identified as risk factors for poor outcomes in patients with sepsis. However, little is known about the effect of tight inpatient glycemic control in the setting of coronavirus disease 2019 (COVID-19). Therefore, we examined the effect of hyperglycemia in patients with diabetes hospitalized because of COVID-19.
We analyzed data from 1,938 COVID-19 patients with diabetes hospitalized for COVID-19 from March to May 2020 at a large academic medical center in New York City. Patients were divided into two groups based on their inpatient glycemic values, and a Cox proportional hazards regression model was used to assess the independent association of inpatient glucose levels with mortality (primary outcome) and the risk of requiring mechanical ventilation (MV) (secondary outcome).
In our analysis, 32% of the patients were normoglycemic and 68% hyperglycemic. Moreover, 31% of the study subjects died during hospitalization, and 14% required MV, with inpatient hyperglycemia being significantly associated with both mortality and the requirement for MV. Additionally, in the Cox regression analysis, after adjustment for potential confounders, including age, sex, race, BMI, HbA1c, comorbidities, inflammatory markers, and corticosteroid therapy, patients with uncontrolled hyperglycemia had a higher risk of dying (hazard ratio [HR] 1.54, 95% CI 1.00-2.36, P = 0.049) and of requiring MV (HR 4.41, 95% CI 1.52-2.81, P = 0.006) than those with normoglycemia.
A tight control of inpatient hyperglycemia may be an effective method for improving outcomes in patients with diabetes hospitalized for COVID-19.
糖尿病和门诊糖尿病治疗方案已被确定为脓毒症患者预后不良的危险因素。然而，对于 2019 年冠状病毒病（COVID-19）背景下的住院患者强化血糖控制的效果知之甚少。因此，我们研究了因 COVID-19 住院的糖尿病患者的高血糖情况。
我们分析了 2020 年 3 月至 5 月期间，纽约市一家大型学术医疗中心因 COVID-19 住院的 1938 例糖尿病 COVID-19 患者的数据。患者根据住院期间的血糖值分为两组，使用 Cox 比例风险回归模型评估住院期间血糖水平与死亡率（主要结局）和需要机械通气（MV）的风险（次要结局）的独立相关性。
在我们的分析中，32%的患者血糖正常，68%的患者血糖升高。此外，31%的研究对象在住院期间死亡，14%需要 MV，住院期间高血糖与死亡率和需要 MV 显著相关。此外，在 Cox 回归分析中，在校正了年龄、性别、种族、BMI、HbA1c、合并症、炎症标志物和皮质类固醇治疗等潜在混杂因素后，血糖控制不佳的患者死亡风险（危险比 [HR] 1.54，95%置信区间 1.00-2.36，P=0.049）和需要 MV 的风险（HR 4.41，95%置信区间 1.52-2.81，P=0.006）均高于血糖正常的患者。
严格控制住院患者的高血糖可能是改善 COVID-19 住院糖尿病患者结局的有效方法。
