COVID-19 associated hyperglycemia

A growing body of evidence indicates that SARS-CoV-2 infection, like other infections, can induce hyperglycemia in people without a previous diagnosis of diabetes.  Compared to patients with normal glucose, COVID-19 patients with hyperglycemia (and without a previous diabetes diagnosis) have been found to be more likely to die than those with known diabetes.  This increased mortality (up to 7-fold in some patient studies), raises the possibility of acute hyperglycemia being an independent risk factor for mortality in COVID-19.  The precise mechanisms triggering hyperglycemia among some COVID-19 patients (as well as those behind new-onset COVID-19-related diabetes) currently remain undetermined.  However, optimal glycemic control during hospitalization is associated with a significantly reduced risk of severe disease and mortality in patients with COVID-19. 
Recommendations for Clinicians
Clinicians should be aware of these interrelated issues and consider screening all hospitalized COVID-19 patients with blood glucose and HbA1c at the time of admission, irrespective of their prior diabetes history1.  Glycemic status should be closely monitored, as optimal glycemic control is crucial in the COVID-19 era and improves prognosis2.  In the absence of contrary evidence, clinicians should interpret COVID-19 associated hyperglycemia as a potential indicator of pancreatic islet cell injury and a risk for a poor outcome3.  The U.S. Food and Drug Administration recently approved the use of continuous glucose monitors in hospitals for people with diabetes, which may facilitate hyperglycemia management during COVID-194.  Primary care doctors can keep in mind the potential of new-onset diabetes and encourage their patients to follow up with them over the course of the next few months or year, post COVID-19 diagnosis, to assess their need for further diabetes screening.  If you have any questions please contact Eastern Idaho Public Health at 208-533-3152.

References
1 Satish, T., Cao, Y., Kapoor, N. Newly Diagnosed Diabetes in COVID-19 Patients. Primary Care Diabetes. 2020 Feb; 15(1):194.
2 Papadokostaki, E., Tentolouris, N., Liberopoulos, E. COVID-19 and Diabetes: What Does the Clinician Need to Know? Primary Care Diabetes. 2020 Oct; 14(5):558-563.
3 Bode, B., Garrett, V., Messler, J., McFarland, R., Crowe, J., Booth, R., Klonoff, D. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. Journal of Diabetes Science and Technology. 2020 May; 14(4):813-821.
4 American Diabetes Association. FDA Expands Remote Patient Monitoring in Hospitals for People with Diabetes During COVID-19.  Accessed 20 May 2021. Available from https://www.diabetes.org/newsroom/press-releases/2020/fda-remote-patient-monitoring-cgm