Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection
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 impa...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002026.full |
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| author | Omar Yaxmehen Bello-Chavolla Jessica Paola Bahena-López Arsenio Vargas-Vázquez Neftali Eduardo Antonio-Villa Roopa Mehta Carlos Alberto Aguilar-Salinas Edgar Ortiz-Brizuela Alejandro Campos-Muñoz Marco Villanueva-Reza María Fernanda González-Lara Alfredo Ponce de León Jose Sifuentes-Osornio |
| author_facet | Omar Yaxmehen Bello-Chavolla Jessica Paola Bahena-López Arsenio Vargas-Vázquez Neftali Eduardo Antonio-Villa Roopa Mehta Carlos Alberto Aguilar-Salinas Edgar Ortiz-Brizuela Alejandro Campos-Muñoz Marco Villanueva-Reza María Fernanda González-Lara Alfredo Ponce de León Jose Sifuentes-Osornio |
| author_sort | Omar Yaxmehen Bello-Chavolla |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d5886f1cfe044a4482798cb203d60763 |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-d5886f1cfe044a4482798cb203d607632025-08-20T02:50:24ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-002026Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infectionOmar Yaxmehen Bello-Chavolla0Jessica Paola Bahena-López1Arsenio Vargas-Vázquez2Neftali Eduardo Antonio-Villa3Roopa Mehta4Carlos Alberto Aguilar-Salinas5Edgar Ortiz-Brizuela6Alejandro Campos-Muñoz7Marco Villanueva-Reza8María Fernanda González-Lara9Alfredo Ponce de León10Jose Sifuentes-Osornio11Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, MexicoMD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, MexicoUnidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoMD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, MexicoDepartamento de Endocrinología y Metabolismo, Unidad de Investigación en Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de Mexico, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoDepartamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoUnidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoDepartamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoDepartamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoDepartamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, MexicoDirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, MexicoIntroduction 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.https://drc.bmj.com/content/9/1/e002026.full |
| spellingShingle | Omar Yaxmehen Bello-Chavolla Jessica Paola Bahena-López Arsenio Vargas-Vázquez Neftali Eduardo Antonio-Villa Roopa Mehta Carlos Alberto Aguilar-Salinas Edgar Ortiz-Brizuela Alejandro Campos-Muñoz Marco Villanueva-Reza María Fernanda González-Lara Alfredo Ponce de León Jose Sifuentes-Osornio Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection BMJ Open Diabetes Research & Care |
| title | Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection |
| title_full | Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection |
| title_fullStr | Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection |
| title_full_unstemmed | Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection |
| title_short | Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection |
| title_sort | impact of undiagnosed type 2 diabetes and pre diabetes on severity and mortality for sars cov 2 infection |
| url | https://drc.bmj.com/content/9/1/e002026.full |
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