Glycemic control and COVID-19 outcomes across the continuum of glucose regulation: a retrospective cohort study.
- 1Department of Quality and Patient Safety, The Southeast Permanente Medical Group, Kaiser Permanente, Atlanta, GA, United States.
- 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Abstract
Coronavirus disease 2019 (COVID-19) has disproportionately affected individuals with underlying metabolic dysfunction. This study investigates the association between varying levels of pre-infection glycemic control and COVID-19-related health outcomes. A retrospective chart review was conducted on Kaiser Permanente Georgia patients with confirmed COVID-19. Participants (N = 2071) were categorized into five groups based on their HbA1c levels: patients without diabetes, those with prediabetes, and those with diabetes with varying degrees of glycemic control. We adjusted for demographics, social determinants of health, comorbidities, medications, and lifestyle factors. Among 2071 patients, 986 (47.6%) were without diabetes, 658 (31.8%) had prediabetes, 183 (8.8%) had diabetes with HbA1c<7%, 162 (7.8%) had diabetes with HbA1c ≥ 7% ≤ 9% and 82 (4%) had diabetes with HbA1c>9%. Patients with HbA1c>9% had the highest proportion hospitalized (38.3%, p<0.001), and admitted to ICU (14.8%, p<0.001). In multivariable logistic regression models, prediabetes and insulin use were associated with greater odds of hospitalization; odds ratio 1.43 [95% CI 1.09-1.87] and 3.02 [95% CI 1.95-4.68], respectively. There is a gradient of increasing COVID-19 severity with worsening glycemic control. The study shows the importance of recognizing prediabetes as a significant risk factor for severe COVID-19, comparable to poorly controlled diabetes.
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BibTeX
@article{mbanya2026glycemic,
title = {{Glycemic control and COVID-19 outcomes across the continuum of glucose regulation: a retrospective cohort study.}},
author = {Armand Mbanya and Serena Leung and Alan Bienvenida and Elizabeth Leslie and Sangmin Ryan Shin and Kate E Koplan and Felipe Lobelo},
journal = {Frontiers in clinical diabetes and healthcare},
year = {2026},
month = oct,
doi = {10.3389/fcdhc.2026.1862850},
url = {https://europepmc.org/article/MED/42953097},
note = {CC BY},
}
RIS
TY - JOUR
TI - Glycemic control and COVID-19 outcomes across the continuum of glucose regulation: a retrospective cohort study.
AU - Armand Mbanya
AU - Serena Leung
AU - Alan Bienvenida
AU - Elizabeth Leslie
AU - Sangmin Ryan Shin
AU - Kate E Koplan
AU - Felipe Lobelo
PY - 2026
DA - 2026/10/14
JO - Frontiers in clinical diabetes and healthcare
DO - 10.3389/fcdhc.2026.1862850
UR - https://europepmc.org/article/MED/42953097
AB - Coronavirus disease 2019 (COVID-19) has disproportionately affected individuals with underlying metabolic dysfunction. This study investigates the association between varying levels of pre-infection glycemic control and COVID-19-related health outcomes. A retrospective chart review was conducted on Kaiser Permanente Georgia patients with confirmed COVID-19. Participants (N = 2071) were categorized into five groups based on their HbA1c levels: patients without diabetes, those with prediabetes, and those with diabetes with varying degrees of glycemic control. We adjusted for demographics, social determinants of health, comorbidities, medications, and lifestyle factors. Among 2071 patients, 986 (47.6%) were without diabetes, 658 (31.8%) had prediabetes, 183 (8.8%) had diabetes with HbA1c<7%, 162 (7.8%) had diabetes with HbA1c ≥ 7% ≤ 9% and 82 (4%) had diabetes with HbA1c>9%. Patients with HbA1c>9% had the highest proportion hospitalized (38.3%, p<0.001), and admitted to ICU (14.8%, p<0.001). In multivariable logistic regression models, prediabetes and insulin use were associated with greater odds of hospitalization; odds ratio 1.43 [95% CI 1.09-1.87] and 3.02 [95% CI 1.95-4.68], respectively. There is a gradient of increasing COVID-19 severity with worsening glycemic control. The study shows the importance of recognizing prediabetes as a significant risk factor for severe COVID-19, comparable to poorly controlled diabetes.
SN - 2673-6616
ER -