ABSTRACT
Objective: Uncontrolled hyperglycaemia is associated with poor clinical outcomes among patients with COVID-19. Diabetes mellitus and hyperglycemia at presentation, are independent risk factors for disease severity and worse outcome of COVID-19 infection. Methods: We evaluated the association of biomarkers of COVID-19 (CRP, D-Dimer and Ferritin) with the random blood sugar (RBS) as reported through SMBG by the patients who were already under regular care, across two dedicated diabetes centres. We compared the levels of CRP, D-Dimer and Ferritin across the groups with RBS < 200 and with RBS ≥ 200, Normal values: CRP 0-5 mg/L, D-Dimer < 0.5 mg/dl, Ferritin 30-400 ng/mL Results: The mean age of the patients was 59 years (SD±13, 95% CI 58 to 60). 256 were male. In our cohort, 378 (87%) were mild cases and 56 (12.9%) were moderate cases. The mean RBS in mild cases at the first consultation was 198 mg/dL (SD±45, 95% CI 170 to 231). The mean CRP (mg/dl), D-Dimer (mg/L) and Ferritin (mg/L) in mild cases were 6.7 (SD±3, 95% CI 5.5 to 7.3), 0.62 (SD±2, 95% CI 0.57 to 6.6) and 485 (SD±34, 95% CI 455 to 516), respectively. The mean RBS in moderate cases at the first consultation was 225 mg/dL (SD±32, 95% CI 196 to 259). The mean CRP (mg/dl), D-Dimer (mg/L) and Ferritin (mg/L) in moderate cases cases were 12.1 (SD±4, 95% CI 6.2 to 13.9), 1.3 (SD±2, 95% CI 0.9 to 1.7) and 655 (SD±42, 95% CI 588 to 691), respectively. There were 92 patients (21.1%) who were initiated on Premixed Analog insulin regimen to achieve glycemic control. Mild cases were managed by standard care approach for diabetes care, including oral drugs. 58 patients (63%) needed uptitration of insulin regimen as the RBS was over 300mg/dL, as a predefined threshold. Discussion/Conclusion: We observed that the T2DM patients with higher grade of hyperglycemia had higher concentrations of prognostic biomarkers. This might have happened due to inflammatory reactions and related tissue destruction. COVID-19 vaccination program should also target those populations with higher RBS to improve their outcomes. We could not quantify the grade of insulin resistance and obesity that would have independently deteriorated the glycemic control with accelerated transition of mild to moderate COVID-19. Our study highlights the need to evaluate COVID-19 biomarkers guided by higher RBS and accordingly predict the progress of mild to moderate cases and timely intervene to manage these patients, while optimally utilising the resources for management of COVID-19.