Implications of a HbA1c based diabetes screening on prevalence and impact of dysglycemia in patients with COVID-19.

ABSTRACT

PURPOSE: In patients with SARS-CoV-2 infection, diabetes is associated with poor COVID-19 prognosis. However, case detection strategy is divergent and reported prevalence varies from 5 to 35%. We examined in how far the choice of screening tools impacts the detection rate of dysglycemia and in consequence the estimation of diagnosis-associated risk for moderate (mo) or severe (s) COVID-19. METHODS: Non-ICU in-patients with COVID-19 were screened systematically at admission for diabetes (D) and prediabetes (PreD) by HbA1c (A), random blood glucose (B) and known history (C) during 01/NOV/2020-08/MAR/2021. Dysglycemia rate and impact on COVID-19 outcome were analyzed in two screening strategies (ABC vs. BC). RESULTS: 578/601 (96.2%) of admitted patients were screened and analyzed. In ABC, prevalence of D and PreD was 38.2 and 37.5%, respectively. D was significantly associated with an increased risk for more severe COVID-19 (aOR(moCOVID-19) 2.27, 95%CI 1.16-4.46 and aOR(sCOVID-19) 3.26, 95%CI1.56-6.38). Patients with PreD also presented more often with more severe COVID-19 than those with normoglycemia (aOR(moCOVID-19) 1.76, 95%CI 1.04-2.97 and aOR(sCOVID-19) 2.41, 95%CI 1.37-4.23). Screening with BC only failed to identify 96% of PreD (206/217) and 26.2% of D diagnosis (58/221) and missed association of dysglycemia and COVID-19 severity. CONCLUSIONS: Pandemic conditions may hamper dysglycemia detection rate and in consequence the awareness of individual patient risk for COVID-19 severity. A systematic diabetes screening including HbA1c reduces underdiagnosis of previously unknown or new onset dysglycemia, enhances the quality of risk estimation and access of patients at risk to a diabetes-specific intervention.