In-Hospital Hyperglycemia and Sliding Scale Insulin Regimen as Risk Factors for Critical Illness and Mortality in Patients with COVID-19 and Type 2 Diabetes Academic Article in Scopus uri icon

abstract

  • Objective: Diabetes mellitus (DM) and in-hospital hyperglycemia are independent risk factors for severe pneumonia and mortality in patients with coronavirus disease 2019 (COVID-19). We aimed to identify the prevalence of critical COVID-19 disease and mortality in hospitalized patients with DM and COVID-19 infection and associated risk factors before the introduction of COVID-19 vaccines. Materials and methods: All hospitalized patients ¿ 18 years old with DM and COVID-19 during 2020 were included. We compared clinical findings and outcomes between survivors and non-survivors. The main risk factors associated with mortality and critical COVID-19 were determined. Results: Among 248 patients, 59.3% were discharged and 40.7% died. Their mean age was 60 ± 12.9 years, and 58.1% were male. Critical COVID-19 was associated with age ¿ 60 years (OR 3.13, p = 0.003), hypoxemia on admission (OR 4.86, p ¿ 0.001), inpatient hyperglycemia (OR 6.15, p = 0.001), and sliding scale insulin (OR 2.70, p = 0.010). Increased mortality was associated with age ¿ 60 years (OR 2.29, p = 0.028), cancer (OR 7.77, p = 0.023), hypoxemia (OR 3.42, p = 0.004) hypotension on admission (OR 10.21, p = 0.044), leukocytosis (OR 2.42, p = 0.048), anemia (OR 3.07, p = 0.013), thrombocytopenia (OR 4.66, p = 0.006), inpatient hyperglycemia (OR 4.44, p = 0.007), and sliding scale insulin (OR 3.24, p = 0.003). The basal bolus regimen was protective mortality (OR 0.17, p = 0.003). Conclusions: COVID-19 was associated with a mortality of 40.7% in hospitalized patients with DM. Inpatient hyperglycemia and sliding scale insulin increased the risk of critical COVID-19 and mortality, while the implementation of a basal plus insulin regimen (basal insulin + sliding scale prandial insulin) protected against mortality. Defining strategies for in-hospital glucose control should be a priority. © 2025 Via Medica. All rights reserved.

publication date

  • January 1, 2025