ArticlePloS one2021
Both high and low pre-infection glucose levels associated with increased risk for severe COVID-19: New insights from a population-based study.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Risk phenotypes of diabetes and association with COVID-19 severity and death: an update of a living systematic review and meta-analysis.Diabetologia · 2023Pooled it
- Metabolic control of macrophages in coronavirus disease 2019.Virulence · 2026Review
- High Glucose Reduces Influenza and Parainfluenza Virus Productivity by Altering Glycolytic Pattern in A549 Cells.International journal of molecular sciences · 2025Article
- Effectiveness of SARS-CoV-2 primary vaccines and boosters in patients with type 2 diabetes mellitus in Hungary (HUN-VE 4 Study).BMJ open diabetes research & care · 2024Article
- Persistence of SARS-CoV-2 IgG Antibody Response among South African Adults: A Prospective Cohort Study.Vaccines · 2023Article
- Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score.Mayo Clinic proceedings · 2023Article
- Article
- Optimal control for the complication of Type 2 diabetes: the role of awareness programs by media and treatment.International journal of dynamics and control · 2023Article
- Glycemic Control and Clinical Outcomes in U.S. Patients With COVID-19: Data From the National COVID Cohort Collaborative (N3C) Database.Diabetes care · 2022Article
- An analytical model of population level chronic conditions and COVID-19 related hospitalization in the United States.BMC public health · 2022Article
- Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2.World journal of hepatology · 2022Review
- Molecular and cellular mechanisms involved in tissue-specific metabolic modulation by SARS-CoV-2.Frontiers in microbiology · 2022Review
- The Association Between Proton Pump Inhibitors and COVID-19 is Confounded by Hyperglycemia in a Population-Based Study.Frontiers in pharmacology · 2022Article
- Modifiable Risk Factors for SARS-CoV-2.Integrative medicine (Encinitas, Calif.) · 2021Article
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
importancePatients with diabetes are known to be at increased risk for infections including severe coronavirus disease 2019 (COVID-19) but the relationship between COVID-19 severity and specific pre-infection glucose levels is not known.
objectiveTo assess the differential effects of pre-infection glucose levels on the risk for severe COVID-19 amongst patients with and without diabetes.
designPopulation based historical cohort study.
settingNational state-mandated HMO. PATIENTS: All adult patients with a positive SARS-COV2 test between March-October 2020. EXPOSURE: Recent fasting blood glucose (FBG) and glycated hemoglobin (HBA1C), age, gender, body mass index (BMI) and diagnoses of diabetes, hypertension, ischemic heart disease. OUTCOME: Risk for severe COVID-19, defined as resulting in ≥10 hospitalization days, ICU admission or death.
results37,121 patients with a positive SARS-COV2 test were identified; 707 defined as severe (1.9%). Unadjusted risk factors for severe disease were age (OR = 1.1 for every year increase; 95% CI 1.09-1.11, p < 0.001), male gender (OR = 1.34, 95% CI 1.06-1.68, p = 0.012); BMI (OR = 1.02 for 1 kg/m2 increase, 95% CI 1.00-1.04, p = 0.025). Controlling for these factors, we found an association between pre-infection FBG and the risk of severe COVID-19, with a differential effect in patients with and without a diagnosis of diabetes. For patients without diabetes, elevated FBG in the pre-diabetes range (106-125 mg/dl) was associated with severe COVID-19 (OR 1.55 95% CI 1.04-2.26 p = 0.027). For patients with a diagnosis of diabetes, we found a J-shaped association between pre-infection glucose control and the risk for severe COVID-19 where the lowest risk for was for patients with FBG 106-125 mg/dl; the risk increased with higher pre-infection glucose levels but strikingly also for patients with a low pre-infection FBG (<100mg/dl) or HbA1C (<5.7%). CONCLUSIONS AND RELEVANCE: Elevated pre-infection blood glucose is a risk factor for severe COVID-19 even in non-diabetics. For patients with a diagnosis of diabetes both high as well as low pre-infection glucose levels are risk factors for severe COVID-19. Further research is required to assess whether these associations are causal, but we believe these findings can already have clinical implications for COVID-19 risk assessment and stratification.
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