Haemoglobin A1c is a predictor of COVID‐19 severity in patients with diabetes. Issue 5 (23rd September 2020)

• Record Type: Journal Article
• Authors: Merzon, Eugene; Green, Ilan; Shpigelman, Miriam; Vinker, Shlomo; Raz, Itamar; Golan‐Cohen, Avivit; Eldor, Roy
• Is Part Of: Diabetes/metabolism research and reviews. Volume 37:Issue 5(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-09-23
• Subjects: coronavirus infectious disease 2019 (COVID‐19) -- pre‐infection glycaemic control; Diabetes -- Periodicals; Metabolism -- Periodicals; 616.642
• DOI: 10.1002/dmrr.3398
• Languages: English
• ISSNs: 1520-7552

Abstract

Abstract: Aim: Poor outcomes of coronavirus disease 2019 (COVID‐19) have been linked to diabetes, but its relation to pre‐infection glycaemic control is still unclear. Materials and Methods: To address this question, we report here the association between pre‐infection Haemoglobin A1c (HbA1c) levels and COVID‐19 severity as assessed by need for hospitalization in a cohort of 2068 patients with diabetes tested for COVID‐19 in Leumit Health Services (LHSs), Israel, between 1 February and 30 April 2020. Using the LHS‐integrated electronic medical records system, we were able to collect a large amount of clinical information including age, sex, socio‐economic status, weight, height, body mass index, HbA1c, prior diagnosis of ischaemic heart disease, depression/anxiety, schizophrenia, dementia, hypertension, cerebrovascular accident, congestive heart failure, smoking, and chronic lung disease. Results: Of the patients included in the cohort, 183 (8.85%) were diagnosed with COVID‐19 and 46 were admitted to hospital. More hospitalized patients were female, came from higher socio‐economic background and had a higher baseline HbA1c. A prior diagnosis of cerebrovascular accident and chronic lung disease conferred an increased risk of hospitalization but not obesity or smoking status. In a multivariate analysis, controlling for multiple prior clinical conditions, the only parameter associated with a significantly increased risk for hospitalization was HbA1c ≥ 9%. Conclusion: Using pre‐infection glycaemic control data, we identify HbA1c as a clear predictor of COVID‐19 severity. Pre‐infection risk stratification is crucial to successfully manage this disease, efficiently allocate resources, and minimize the economic and social burden associated with an undiscriminating approach.