Abstract

Objective: To determine the association between the HbA1C level and prognosis of COVID-19 in diabetic patients.

Aim: SARS-CoV has emerged as a major economical and health crisis in the modern world. New strains and diverse clinical cases possess management challenges. As diabetes is found to be common comorbidity among the COVID infected individuals, our study focuses on the impact of diabetes control i.e. HbA1C levels on the outcome and severity of illness.

Methodology: This is a retrospective cohort study. Data were collected retrospectively from the registry. COVID patients with prediabetes, diabetes and newly diagnosed diabetes were included from April 2020 to March 2021, in the COVID units of Patel hospital Karachi, Pakistan. Asymptomatic stages of COVID-19 were excluded from the study. Study participants were included in the survey by purposive sampling. All the patients diagnosed with COVID-19 were recorded for demographic data, past medical history, history of comorbid conditions, symptoms, laboratory random blood sugars, HbA1C levels, radiological findings and outcomes. The control of diabetes was compared with the severity of symptoms, clinical stage of disease, oxygen demand, and also the outcome of the disease in terms of hospital stay and mortality.

Results: 82 COVID patients with previous or newly diagnosed diabetes were included in the study. Mean age was 61 years, 71% (n=58) were male, 29% (n=24) were female. 73% (n=60) were diagnosed cases of diabetes, while 26.83% (n=22) were newly diagnosed diabetes. On comparing HbA1C levels with age and gender no significant relationship was found but smoking and diabetes without end organ damage was significantly related to the worsening HbA1c i.e. uncontrolled diabetes. Comparison of HbA1C levels with severity of illness showed that most patients 63.2% (n=36) with the severe stage of COVID-19 were having uncontrol HbA1C levels i.e. HbA1C >7.5%. 63% (n=44) had respiratory failure depicting a higher ratio of respiratory failure in the uncontrolled HbA1C group. However HbA1C levels were not found to have a significant effect on mortality. HbA1c levels do not have an impact on the length of stay of patients but significant correlation with PFR i.e. PaO₂ and FiO₂ ratio which is a marker of respiratory failure.

Conclusion: As diabetic patients who contracted COVID-19 infection are more prone to get severe illness, this signifies the importance of diabetes control as one of the key management and safety strategy for COVID-19 infection. However, it has little impact on mortality.

Keywords: COVID-19; HbA1C; Radiological findings; Prognosis; Diabetes