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Well-Controlled T2D Glucose Levels Improves COVID-19 Outcomes

Pharmacists often are focused on helping type 2 diabetes patients improve their blood glucose control. A new study from China shows how important that is during the COVID-19 pandemic, when those patients with well-controlled blood sugars fared much better than those without.

WUHAN, CHINA – Here is another compelling reason for pharmacists to help type 2 diabetes patients better control their blood sugar levels: It could help save their lives if they become infected with COVID-19.

That’s according to a study in the journal Cell Metabolism. While it adds to the evidence that people with type 2 diabetes (T2D) are at greater risk of a poor outcome should they become infected with the virus that causes COVID-19, it also report that patients with well-controlled glucose levels fare much better than those without.

https://www.cell.com/cell-metabolism/fulltext/S1550-4131(20)30238-2

"We were surprised to see such favorable outcomes in well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes," says senior author Hongliang Li of Renmin Hospital of Wuhan University. "Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes."

To determine the effect of blood glucose control on novel coronavirus outcomes, the researchers. conducted a retrospective longitudinal multi-centered study including 7,337 confirmed COVID-19 cases enrolled among 19 hospitals in Hubei Province, China. Of those, 952 people had T2D and the other 6,385 did not. In addition, among those with diabetes, 282 had well-controlled blood glucose; the other 528 did not.

For purposes of the study, those with relatively well-controlled blood glucose regulation were defined as having an upper limit of 10 mmol/L or less, while those with poorly controlled blood glucose were defined as having an upper limit of greater than 10 mmol/L. That roughly translates to an hemoglobin A1c level of slightly less than 8%, according to a Mayo Clinic chart.

https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643

Results indicate that patients with T2D required more medical interventions for COVID-19 and also had significantly higher mortality -- 7.8% vs. 2.7% -- as well as a greater incidence of multiple organ injury.

Those with well-controlled blood sure not only were less likely to die of the disease than those whose blood glucose was poorly controlled, according to researchers, but they also received less of other medical interventions including supplemental oxygen and/or ventilation and had fewer health complications.

Based on those findings, researchers make the following recommendations:

• T2D patients have a higher risk to die from COVID-19 and develop more severe complications after infection. As a result, they should take extra precautions to avoid becoming infected.
• In addition, those patients should take extra care to keep their blood sugar under good control during the pandemic.
• Once infected, patients with diabetes should have their blood glucose level controlled to maintain it in the right range, in addition to any other needed treatments.

“For individuals with COVID-19 and pre-existing T2D, a key challenge for clinicians is to improve outcomes in the face of uncertainty regarding the degree of glycemic management that should be maintained and any effects this might have on the benefits and risks of overall treatment. Thus, detailed analyses of data from such patients is needed that links plasma glucose levels with clinic outcomes, including mortality,” the researchers explain.

They emphasize that their study “indicated that well-controlled glycemia was associated with a markedly improved outcome of patients with COVID-19 and pre-existing T2D.”