Fast Five Quiz: Type 2 Diabetes Key Aspects

Romesh Khardori, MD, PhD


August 18, 2020

A strong link has been observed between glucose control and COVID-19 outcomes among hospitalized patients with preexisting T2D. Among 952 patients with COVID-19 and T2D, 282 individuals had "well-controlled" blood glucose, ranging from 3.9 to 10 mmol/L (median, 6.4 mmol/L [115 mg/dL]) and an A1c level of 7.3%. Those with "poorly controlled" blood glucose, defined as the lowest fasting glucose level ≥ 3.9 mmol/L or above and the highest 2-hour postprandial glucose > 10 mmol/L (median, 10.9 mmol/L [196 mg/dL]) and A1c level of 8.1%, had a higher mortality rate.

More than 1 in 10 people with diabetes hospitalized with COVID-19 die within 1 week, and nearly one third require mechanical ventilation, new research shows. Data from the French Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study also reveal that body mass index (BMI) was independently associated with death or intubation at 7 days, whereas A1c level and use of renin-angiotensin-aldosterone system blockers and dipeptidyl peptidase 4 (DPP-4) inhibitors were not.

A retrospective study by Chen and colleagues of 136 patients with COVID-19 and T2D found that older age, elevated C-reactive protein level, and insulin use were risk factors for mortality. The adjusted odds ratio for mortality in insulin use was 3.58. Whether insulin itself is a risk factor or whether the increased mortality reflects the characteristics of the patients taking it is unclear.

Women taking metformin may be at lower risk for fatal COVID-19, according to a recent study. Among more than 6200 adults with diabetes or obesity who were hospitalized for COVID-19, fewer deaths were reported among women who had filled their 90-day metformin prescriptions. After adjustment for other risk factors, these women were 21%-24% less likely to die of COVID-19. This link was not observed among men.

Although the risk for death from COVID-19 is significantly increased in people with both main types of diabetes, early findings suggest that the highest risk is associated with T1D.

Read more about COVID-19 and diabetes.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.