Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection
Por:
Vargas-Vazquez, Arsenio, Bello-Chavolla, Omar Yaxmehen, Ortiz-Brizuela, Edgar, Campos-Munoz, Alejandro, Mehta, Roopa, Villanueva-Reza, Marco, Bahena-Lopez, Jessica Paola, Antonio-Villa, Neftali Eduardo, Gonzalez-Lara, Maria Fernanda, Ponce de Leon, Alfredo, Sifuentes-Osornio, Jose, Aguilar-Salinas, Carlos Alberto
Publicada:
1 ene 2021
Categoría:
Endocrinology, diabetes and metabolism
Resumen:
Introduction Diabetes and hyperglycemia are risk factors for critical COVID-19 outcomes; however, the impact of pre-diabetes and previously unidentified cases of diabetes remains undefined. Here, we profiled hospitalized patients with undiagnosed type 2 diabetes and pre-diabetes to evaluate its impact on adverse COVID-19 outcomes. We also explored the role of de novo and intrahospital hyperglycemia in mediating critical COVID-19 outcomes. Research design and methods Prospective cohort of 317 hospitalized COVID-19 cases from a Mexico City reference center. Type 2 diabetes was defined as previous diagnosis or treatment with diabetes medication, undiagnosed diabetes and pre-diabetes using glycosylated hemoglobin (HbA1c) American Diabetes Association (ADA) criteria and de novo or intrahospital hyperglycemia as fasting plasma glucose (FPG) =140 mg/dL. Logistic and Cox proportional regression models were used to model risk for COVID-19 outcomes. Results Overall, 159 cases (50.2%) had type 2 diabetes and 125 had pre-diabetes (39.4%), while 31.4% of patients with type 2 diabetes were previously undiagnosed. Among 20.0% of pre-diabetes cases and 6.1% of normal-range HbA1c had de novo hyperglycemia. FPG was the better predictor for critical COVID-19 compared with HbA1c. Undiagnosed type 2 diabetes (OR: 5.76, 95% CI 1.46 to 27.11) and pre-diabetes (OR: 4.15, 95% CI 1.29 to 16.75) conferred increased risk of severe COVID-19. De novo/intrahospital hyperglycemia predicted critical COVID-19 outcomes independent of diabetes status. Conclusions Undiagnosed type 2 diabetes, pre-diabetes and de novo hyperglycemia are risk factors for critical COVID-19. HbA1c must be measured early to adequately assess individual risk considering the large rates of undiagnosed type 2 diabetes in Mexico. ©
Filiaciones:
Vargas-Vazquez, Arsenio:
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
Bello-Chavolla, Omar Yaxmehen:
Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
Ortiz-Brizuela, Edgar:
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Campos-Munoz, Alejandro:
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Mehta, Roopa:
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
Villanueva-Reza, Marco:
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Bahena-Lopez, Jessica Paola:
MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
Antonio-Villa, Neftali Eduardo:
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
Gonzalez-Lara, Maria Fernanda:
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Ponce de Leon, Alfredo:
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Sifuentes-Osornio, Jose:
Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
Aguilar-Salinas, Carlos Alberto:
Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
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