A newly published Israeli study shows that elevated pre-infection blood sugar levels – even in those who do not suffer from diabetes – are correlated with a greater risk of severe COVID-19 cases.
The study built on existing data that showed diabetes was one of the comorbidities for which people were at a higher risk for severe COVID-19 infection, likely resulting in hospitalization at least. However, this latest research from the Hebrew University of Jerusalem, the Meuhedet HMO, Jerusalem College of Technology (JCT), and Hadassah Medical Center represented the first study to explore the correlation between sugar levels and the risk of severe COVID-19 morbidity regardless of diabetes diagnosis.
While the highest risk of existing patients diagnosed with diabetes of contracting severe COVID-19 (1 of 4) was found in patients with low sugar values — below 80 mg/dl, the lowest risk (1 of 12) was found in patients with sugar values of 106-125 mg/dl. (The standard blood sugar level for an adult is 70-100 mg/dL, after having fasted at least eight hours).
For patients with no diagnosis of diabetes, the higher the sugar values, the greater the risk of severe COVID-19. Patients with sugar values while fasting of 105-125 mg/dl were one-and-a-half times more at risk of developing severe COVID-19 than patients with sugar values less than 105. Patients with sugar values of 125-140 mg/dl were twice as likely to develop COVID-19 complications than patients with sugar values less than 105.
The study examined all members of the Mehudet HMO, who are over the age of 18, including some 37,000 subjects (16.7 percent of the total group) who registered a positive COVID-19 PCR test between March and October 2020.
“The aim of the study was to locate risk factors for COVID-19 severe morbidity which could be handled in advance, so we could raise the awareness of those factors among the general public,” said Dr. Michal Shauly-Aharonov, a biostatistician at the Department of Industrial and Management Engineering at JCT and Hebrew University’s School of Public Health in a statement from the Jerusalem College of Technology (JCT). “Locating factors related to severe morbidity and death, G-d forbid, is important principally to shed light on the populations at risk, so they can receive priority in receiving vaccines. As far as we know, no population-based studies had previously been published correlating glucose levels before infection and the risk level of contracting COVID-19 in patients suffering or not suffering from diabetes.”
Dr. Aharonov was first alerted to the potential importance of mining data to investigate the incidence of the correlation between blood sugar levels and the severity of COVID-19, after a colleague, family physician Dr. Asher Shafrir said that he had a huge data set from the Meuhedet HMO. He had collated data from the previous year, before the patients had received either a positive or negative coronavirus test.
Speaking to NoCamels, she says that she started looking at the data to try and detect risk factors, while comparing “a non-life-threatening infection,” and “those with complications; identified as spending more than 10 days in hospital, or requiring admittance to the ICU or who unfortunately died of the disease.”
She explains that many risk factors and comorbidities were known fairly early on in the pandemic and that diabetes, age, gender and severe chronic diseases could likely lead to serious infection. Her main goal she says is to try and explain the importance of regulating blood sugar level and how an awareness of it can affect how the body might respond to a disease such as COVID. And if she had a phrase in mind, it is “prevention is better than cure.”
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Dr. Orit Bernholtz-Gulchin, head of the Meuhedet HMO regional diabetes clinic, said the findings meant that the medical community’s emphasis “should be placed on preventing hypoglycemia (a condition in which blood sugar level drops radically from normative levels) in populations found to be at risk of severe COVID-19 comorbidity.”
Research has shown that COVID-19 patients with diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), hypertension, and other comorbidities — as well as old age — could help it develop into a more serious-life-threatening illness. Doctors and medical professionals have been aware of this since early into the pandemic.
The researchers also recommended paying special attention to patients with no diagnosis of diabetes who show abnormal sugar levels during fasting or who show elevated HbA1C hemoglobin levels, as well as low sugar-value diabetics, who are also at increased risk of COVID-19 complications.
“The study shows very strongly how much can be learned from quality and continuous medical recording, such as the one we have in the Israeli health care system,” said Prof. Ora Paltiel of Hebrew University’s School of Public Health.
Meanwhile, Israeli data from the COVID-19 booster shot program, which the government rolled out on August 1, and has administered inoculation shots to nearly three million people so far, will be used to guide vaccine advisers to the US Food and Drug Administration (FDA).
The data will be peer-reviewed in the New England Journal of Medicine, a key step in helping the FDA’s Vaccines and Related Biological Products Advisory Committee when they meet on September 17. Their findings will be instrumental in whether the United States rolls out its own booster vaccination program.