Diabetic, pre-diabetic patients and those with high fasting blood sugar at higher risk of fatality due to COVID-19

The levels of ACE-2 increase in a diabetic person (a condition with high blood glucose levels) which allows the virus to attack the organs of the diabetic person in a more disastrous way.

Myupchar July 13, 2020 16:44:38 IST
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Diabetic, pre-diabetic patients and those with high fasting blood sugar at higher risk of fatality due to COVID-19

The COVID-19 pandemic is taking a huge toll globally and in an effort to control the situation, effective measures to lower the death rate have to be taken. Doctors have already stated that people with any comorbidities are at a higher risk of getting severe symptoms of COVID-19 infection.

Those with systemic conditions such as diabetes, high blood pressure and heart conditions are advised to be extra cautious. But in a recent study published in the journal Diabetology on 10 July 2020, the scientists stated that COVID-19 patients who have higher levels of fasting blood glucose can be at risk of death within 28 days of becoming infected -- even if they have not been diagnosed with diabetes ever in their life.

How diabetes increases the risk of COVID-19 infection in a person?

The fluid and electrolyte balance of the body is maintained with the help of the renin-angiotensin system. When a person complains of low blood pressure, the renin (present in the kidney) forms angiotensin I by breaking down the enzyme ‘angiotensinogen’.

To become active, angiotensin I gets converted into angiotensin II with the help of the angiotensin-converting enzyme (ACE).

This ACE (usually present on the lungs, kidney and heart) binds to the ACE receptors and squeezes the blood vessels, thus raising the blood pressure of the body. Then comes ACE-2 which helps in breaking down angiotensin II into molecules that neutralise the harmful effects of angiotensin II.

This novel coronavirus , SARS-CoV-2, has a high affinity for ACE-2 receptors present on the surface of healthy cells. Thus it attaches itself to the ACE-2 and attacks the lungs, kidney and heart.

The levels of ACE-2 increase in a diabetic person (a condition with high blood glucose levels) which allows the virus to attack the organs of the diabetic person in a more disastrous way.

Assessing the effect of several variables on COVID-19 patients in 28 days

The study conducted at the Wuhan Union West Hospital and Wuhan Red Cross Hospital included 605 patients (without a previous diagnosis of diabetes) out of which 208 patients had one or more pre-existing diseases, mostly hypertension.

Out of all these people, 332 were men and the median age was 59 years and during admission, most of the patients were experiencing fever, cough and fatigue.

All these patients were given standard treatment from 24 January 2020 to 10 February 2020 which included antiviral therapy, breathing support in the form of high-flow nasal cannula oxygen therapy, non-invasive ventilation or invasive mechanical ventilation and other antimicrobial therapies to prevent or treat secondary infections.

On admission, the doctors tested the CRB-65 levels of these patients, which showed that 334 patients had a CRB-65 score of 0, a total of 261 had a CRB-65 score between 1 and 2 and 10 patients had a CRB-65 score between 3 and 4. The CRB-65 score is a clinical score which helps in ruling out the severity of community-acquired pneumonia within the 30-day period.

The doctors also tested the fasting blood glucose of these patients, which was less than 6.1 mmol/l for 329 patients, 6.1–6.9 mmol/l for 100 patients and more than 7.0 mmol/l for 176 patients.

Normally, the fasting blood sugar level less than 5.6 mmol/L is normal, from 5.6 to 6.9 mmol/L is considered prediabetes and at or above 7 mmol/L indicates diabetes.

Within this period of 28 days, 114 patients died during their stay in the hospital. The doctors found that these people were in the older age group and had the cerebrovascular disease (diseases that affect blood vessels and blood supply to the brain).

Result of the study

On comparing the surviving patients with the ones who died, the scientists found that age, sex, pre-existing chronic kidney disease, cerebrovascular disease, CRB-65 score and fasting blood glucose levels were associated with in-hospital 28-day mortality.

The doctors found that the people who died were in the older age group and had a history of cerebrovascular disease. But more than that, these people had a CRB-65 score of 1 to 2 and 3 to 4 and fasting blood glucose levels of more than 7.0 mmol/l.

The data showed that patients with fasting blood glucose of less than 6.1 mmol/l had a lower risk of getting complications and death when compared with those who had fasting glucose levels of 6.1 to 6.9 mmol/l and ≥7.0 mmol/l respectively.

Similarly, people with CRB-65 of 1 to 2 and 3 to 4 had a higher risk of death.

With this study, the scientists confirmed that people who have not been diagnosed with diabetes ever before but have high levels of blood glucose, like pre-diabetics, are at a higher risk of getting severe symptoms of COVID-19 infection and even death. They further stated conditions like severe sepsis, systemic inflammatory response syndrome (SIRS) and traumatic brain injury were also prevalent in non-diabetic people with high blood sugar.

For more information, read our article on Why coronavirus is more dangerous for diabetes patients.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

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