Hyperglycemia as a Complication of COVID 19: An Observational Study

Abstract

Background: Hyperglycemia has got a bidirectional importance in COVID 19, on one end it causes aberrant glycation of ACE receptors in the lungs causing more severe disease and on the other end it may occur as a result of complications of the disease itself.

Objectives: To determine whether hyperglycemia is a complication of COVID-19.

Methods: A cross-sectional observational study was conducted on 126 admitted, moderate to severe COVID-19 patients, to observe new-onset hyperglycemia in relation to their previous glycemic control (glycated hemoglobin levels HbA1c). Blood sugar random (BSR) noted at time of admission was taken as the dependent variable and HbA1c, body mass index and severity of disease as independent variables to find out association. Patients who were known diabetic and already taking steroids were excluded from study.

Results: A total of 126 patients (66 male and 60 female) included in the study with a mean age 56.9 yrs. ± 11.8. Based on admission HbA1c, 71(56.4%) patients were non-diabetic, 35(27.7%) pre-diabetic, and 20(15·9%) were diabetic. Initial random blood sugar revealed overall 31(24.6%) patients had normoglycemia, while 95(75.4%) had hyperglycemia, more precisely 67(53.2%) had moderate and 28 (22.2%) had severe hyperglycemia. Hyperglycemia was observed among 9 out of 12 (75%) patients from 20-39 years age group, 51 out of 61 (83%) patients from 40-59 years age group and 35 out of 53 (66%) from 60-75 years age group. Eighty percent male and 76% female had hyperglycemia. Nineteen (15%) were of normal weight, 79 (62.8%) overweight and 28 (22·2%) were obese. The moderate and severe hyperglycemia for 95(75%) patients showed that 49(51·6%) had non-diabetic HbA1c, 27(28·4%) had prediabetes HbA1c and 19 (20%) had diabetic range HbA1c. Further linear association was determined between BSR and HbA1c, p<0•001. Among 31 normoglycemic patients it was found that 13(41.9%) patient were of normal weight, 17(54.8%) patients were overweight and one (3.3%) patients was obese. Moreover, Body Mass Index (BMI) and severity of disease were found to have significant association with new onset hyperglycemia with P <0∙001 and P=0∙01 respectively.

Conclusion: There is an association between new-onset hyperglycemia and moderate to severe COVID-19 disease.  Follow-up studies are required to prove the diabetogenic effect of COVID 19.