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COVID patients with poorly managed Type 2 diabetes 50% more likely to go to ICU, study says

November 23, 2021
Centre Daily Times
By Katie Camero

Diabetes is a well-known risk factor for COVID-19, but new research suggests not all people with the condition face the same consequences.

COVID-19 patients with Type 2 diabetes who fail to properly manage their blood sugar levels over two to three years are nearly 50% more likely to end up in the intensive care unit compared to those with a more controlled blood sugar history.

Put another way, a 1% increase in hemoglobin A1C — the percentage of red blood cells that have proteins called hemoglobin coated in sugar — is “directly associated” with a 12% boost in the likelihood of winding up in the ICU due to COVID-19, according to the study.

People with “poor” long-term blood sugar had A1C levels at or above 9%, while those with “adequate” blood sugar control had A1C levels between 6% and 9%. Generally, any A1C level below 5.7% is considered normal.

Researchers also found people with Type 2 diabetes who were taking metformin, a widely used anti-diabetic medication, at the time of their coronavirus infection had a 12% lower risk of needing ICU care; those who were taking metformin and insulin had a 18% lower risk and patients on corticosteroids had a 29% lower risk of ending up in the ICU.

The team analyzed more than 16,000 electronic health records of people with Type 2 diabetes and COVID-19 between 2017 and 2020. The study was published in September in the journal BMJ Open Diabetes Research & Care.

“Some people have a longer history of diabetes, some have more severe diabetes, and that has to be accounted for,” study first author Bowen Wang, a doctoral student in the Center for Biotechnology and Interdisciplinary Studies at Rensselaer Polytechnic Institute in New York, said in a news release posted Nov. 18. “What this study does is to better stratify the level of diabetes within the population, so diabetic patients aren’t treated as a single population without any differences among them.”

A separate recently published study also found people with Type 2 diabetes may already be taking medications that reduce their risks of severe COVID-19, including hospitalization, respiratory complications and death.

Glucagon-like peptide-1 receptor (GLP-1R) agonists are known to reduce inflammation in the body, a problem that people with Type 2 diabetes often struggle with. COVID-19 is also known to trigger extreme inflammatory responses in severe cases.

People with Type 2 diabetes who were taking GLP-1R agonists within six months before getting infected with the coronavirus benefited from a 33% reduced risk of coronavirus-related hospitalization, 38% lower risk of respiratory complications and 42% reduced risk of death when matched with people of similar characteristics.


More than 34 million people in the U.S. have diabetes, according to the Centers for Disease Control and Prevention. But about 90-95% of them have Type 2.

Type 2 diabetes manifests over many years and occurs when your body doesn’t use or make enough insulin — a hormone that regulates the amount of sugar in blood — as it should. It’s common for people with this kind of diabetes to not notice any symptoms before diagnosis, so experts suggest those at risk should take regular blood tests.

Chronic high blood sugar levels can damage your circulatory, nervous and immune systems, leading to problems such as heart disease, vision loss and kidney disease. The condition can be prevented or delayed with the help of a healthy lifestyle, including proper diet, exercise and weight management.

Type 2 diabetes mostly occurs in people over 45 years old, but a growing number of children, teens and young adults are developing it. A study published in August found that the number of people under 20 years old living with Type 2 diabetes grew by 95% from 2001 to 2017.

It’s difficult to pinpoint exactly why diabetes diagnoses are seeing what experts call “concerning increases,” but researchers of the study speculate rising rates of childhood obesity, exposure to obesity and diabetes in utero, and increased diabetes screenings may play a role.

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