The following is a summary of “Implications of an HbA1c-based Diabetes Screening on Prevalence and Effect of Dysglycemia in Patients With COVID-19,” published in the March 2023 issue of Endocrinology & Metabolism by Baal, et al.

The prevalence of diabetes in COVID-19 patients varies widely, from 5% to 35%, and is associated with poorer COVID-19 prognosis. For a study, researchers sought to investigate the effect of screening tools on the detection rate of dysglycemia and the subsequent estimation of COVID-19-associated risk in non-ICU hospitalized patients.

From November 1, 2020, to March 8, 2021, non-ICU hospitalized COVID-19 patients were screened for diabetes and prediabetes using glycated hemoglobin A_1c (HbA_1c) (A), random blood glucose (B) and known history (C). The rates of dysglycemia and its association with COVID-19 severity were analyzed using two screening strategies: A, B, and C versus B and C alone.

Of the 601 admitted patients, 578 (96.2%) were screened. Using the A, B, and C strategies, the prevalence of diabetes and prediabetes was 38.2% and 37.5%, respectively. Diabetes was significantly associated with an increased risk for more severe COVID-19 (adjusted odds ratio [aOR] for moderate COVID-19: 2.27, 95% CI, 1.16-4.46; aOR for severe COVID-19: 3.26, 95% CI, 1.56-6.38). Prediabetes was also associated with a higher risk of severe COVID-19 (aOR for moderate COVID-19: 1.76, 95% CI, 1.04-2.97; aOR for severe COVID-19: 2.41, 95% CI, 1.37-4.23). Screening with the B and C strategy missed the diagnosis of prediabetes in 96% of cases (206/217) and failed to identify 26.2% of diabetes diagnoses (58/221), resulting in missed associations of dysglycemia and COVID-19 severity.

The pandemic may reduce the detection rate of dysglycemia and thus increase the risk of severe COVID-19. A systematic diabetes screening, including HbA_1c, can improve the detection of dysglycemia and enhance the accuracy of risk estimation and access of patients to appropriate diabetes-specific interventions.

Reference: https://academic.oup.com/jcem/article/108/3/697/6758527