The relation of HbA1c levels with mortality rates in hospitalized COVID-19 diabetic patients: A Retrospective Cohort Study conducted in Egypt

Abstract

Background: Identifying mortality factors in type 2 diabetic patients with COVID-19 is crucial. Objectives: To investigate the association between HbA1c levels and mortality rates in hospitalized COVID-19 diabetic patients. Methods: A 5-month retrospective cohort study at Al-Agouza hospital in Egypt included 167 adult COVID-19 diabetic patients. Patients were categorized by HbA1c levels at admission(≤ 7%, 7.1% to 8.9%, and ≥ 9%). Hospital mortality was the primary outcome. Results: The mean age was 66±10.2 years and the majority (56.3%) of patients were males. Out of 167 patients, 51 (30.5%) had HbA1c ≤ 7%, 77 (46.1%) had HbA1c between 7.1% and 8.9%, and 39 (23.4%) had HbA1c ≥ 9%.The average hospital stay was 12 days. Approximately 35.3% of patients required ICU admission and 35.9% died. The lowest HbA1c levels (≤ 7%) were associated with highest mortality rates (43.1%), however the difference did reach not statistical significance (p=0.385). The multivariate Cox regression analysis demonstrated a significant association between age ≥ 70 years (HR 1.85, 95% CI 1.04 -3.28), severe and critically ill cases (HR 9.88, 95% CI 1.19-82.18), ICU admission (HR 7.66, 95% CI 2.94-19.97), and the administration of insulin sliding scale as hospital glycemic management medication (HR 0.45, 95% CI 0.21-0.96) with mortality in COVID-19 diabetic patients. Conclusions: This study challenges the conventional belief regarding the association between HbA1c levels and mortality in COVID-19 diabetic patients. Nevertheless, age, COVID severity, ICU admission, and the use of insulin sliding scale emerged as significant risk factors for mortality in this population.