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Admission Blood Glucose Level and Its Association With Cardiovascular and Renal Complications in Patients Hospitalized With COVID-19.

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posted on 2022-06-14, 10:28 authored by Tom Norris, Cameron Razieh, Thomas Yates, Francesco Zaccardi, Clare L Gillies, Yogini V Chudasama, Alex Rowlands, Melanie J Davies, Gerry P McCann, Amitava Banerjee, Annemarie B Docherty, Peter JM Openshaw, J Kenneth Baillie, Malcolm G Semple, Claire A Lawson, Kamlesh Khunti


To investigate the association between admission blood glucose levels and risk of in-hospital cardiovascular and renal complications.

Research design and methods

In this multicenter prospective study of 36,269 adults hospitalized with COVID-19 between 6 February 2020 and 16 March 2021 (N = 143,266), logistic regression models were used to explore associations between admission glucose level (mmol/L and mg/dL) and odds of in-hospital complications, including heart failure, arrhythmia, cardiac ischemia, cardiac arrest, coagulation complications, stroke, and renal injury. Nonlinearity was investigated using restricted cubic splines. Interaction models explored whether associations between glucose levels and complications were modified by clinically relevant factors.


Cardiovascular and renal complications occurred in 10,421 (28.7%) patients; median admission glucose level was 6.7 mmol/L (interquartile range 5.8-8.7) (120.6 mg/dL [104.4-156.6]). While accounting for confounders, for all complications except cardiac ischemia and stroke, there was a nonlinear association between glucose and cardiovascular and renal complications. For example, odds of heart failure, arrhythmia, coagulation complications, and renal injury decreased to a nadir at 6.4 mmol/L (115 mg/dL), 4.9 mmol/L (88.2 mg/dL), 4.7 mmol/L (84.6 mg/dL), and 5.8 mmol/L (104.4 mg/dL), respectively, and increased thereafter until 26.0 mmol/L (468 mg/dL), 50.0 mmol/L (900 mg/dL), 8.5 mmol/L (153 mg/dL), and 32.4 mmol/L (583.2 mg/dL). Compared with 5 mmol/L (90 mg/dL), odds ratios at these glucose levels were 1.28 (95% CI 0.96, 1.69) for heart failure, 2.23 (1.03, 4.81) for arrhythmia, 1.59 (1.36, 1.86) for coagulation complications, and 2.42 (2.01, 2.92) for renal injury. For most complications, a modifying effect of age was observed, with higher odds of complications at higher glucose levels for patients age <69 years. Preexisting diabetes status had a similar modifying effect on odds of complications, but evidence was strongest for renal injury, cardiac ischemia, and any cardiovascular/renal complication.


Increased odds of cardiovascular or renal complications were observed for admission glucose levels indicative of both hypo- and hyperglycemia. Admission glucose could be used as a marker for risk stratification of high-risk patients. Further research should evaluate interventions to optimize admission glucose on improving COVID-19 outcomes.


This work was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), NIHR Applied Research Collaboration–East Midlands (ARC-EM), the UK Research and Innovation Department of Health and Social Care (UKRI-DHSC) COVID-19 Rapid Response Rolling Call (grant MR/V020536/1), Health Data Research (HDR)-UK (grant HDRUK2020.138), the NIHR (award CO-CIN-01), the Medical Research Council (MRC) (grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at the University of Liverpool.



Diabetes Care 2022;45(5):1132–1140

Author affiliation

Diabetes Research Centre, College of Life Sciences, University of Leicester


  • AM (Accepted Manuscript)

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Diabetes care








American Diabetes Association





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United States



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