IDF21-0311 Pre-Admission, Diabetic Glycemic Control on 60-Day Mortality and Major Adverse Cardiovascular Events from COVID-19

ABSTRACT

Background: Patients with diabetes mellitus (DM) are at increased risk for intubation, death, and other complications from COVID-19. However, the importance of a patient’s glycemic control preceding the COVID-19 infection is less well understood. Method: From March to November 2020, data from adult patients with confirmed COVID-19 admitted to Rush University System for Health (RUSH) was studied. Patients with both a pre-existing history of diabetes mellitus (DM) and a hemoglobin A1c (HbA1c) measurement during their hospitalization were included. Based on their HbA1c, patients were then divided into 4 groups adequate glycemic control (≤ 6.5), mild elevation (6.5 – 7.4), intermediate elevation (7.5 – 8.4), and severe elevation (≥ 8.5). Multivariable logistic regression, adjusted for age, body mass index, and pre-existing history of atrial fibrillation, coronary artery disease, hypertension, and chronic obstructive pulmonary disorder, was performed with glycemic control group as a predictor for 60-day mortality and severe COVID-19, which was a composite of 60-day mortality or requiring the intensive care unit, non-invasive positive pressure ventilation, or mechanical ventilation. Major adverse cardiac events (MACE) were defined as nonfatal myocardial injury, nonfatal stroke, or cardiovascular death. Results: Of the 1682 patients admitted, 774 had pre-existing DM, and 534 had HbA1c measurement during their hospitalization. The median HbA1c value was 8.0% (interquartile range 6.6% – 9.9%). In our entire cohort, 75 (14.0%) and 280 (52.4%) patients suffered 60-day mortality and severe COVID-19 infection, respectively. When adjusting for baseline characteristics and comorbidities, patients with mild (adjusted odds ratio [aOR] 2.39 [CI 1.04 – 5.83];p < 0.05) and intermediate (aOR 3.59 [CI 1.49 – 9.12];p < 0.01) HbA1c elevation were at increased risk of 60-day mortality compared to those with adequate glycemic control;no statistically significant difference was present in those with severe elevation (aOR 2.19 [CI 0.95 – 5.44];p = 0.08). Furthermore, only the mild HbA1c elevation group was at increased risk for severe COVID-19 infection (aOR 1.88 [CI 1.06 – 3.38];p < 0.05). Those with intermediate (aOR 1.77 [CI 0.94 – 3.33];p = 0.08) or severe (aOR 1.57 [CI 0.92 – 2.70];p = 0.10) HbA1c elevation were not at higher risk for severe COVID-19 infection. When comparing other 60-day outcomes, there was no difference between the glycemic groups in MACE, life-threatening arrhythmia, deep venous thrombosis, acute renal failure requiring renal replacement therapy, and pulmonary embolism (Table 1). Discussion: In our cohort, patients with DM with an HbA1c of 6.5 – 8.4 were at increased risk of 60-day mortality, while those with an HbA1c of 6.5 – 7.4 were at an increased risk of severe COVID-19 infection.