Blood glucose, diabetes and metabolic control in patients with community-acquired pneumonia
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LETTER
Blood glucose, diabetes and metabolic control in patients with community-acquired pneumonia Philipp M. Lepper 1
&
Robert Bals 1 & Peter Jüni 2,3 & Maximilian von Eynatten 4
Received: 18 June 2020 / Accepted: 25 June 2020 # The Author(s) 2020
Keywords Community-acquired pneumonia . COVID-19 . Diabetes mellitus . Hyperglycaemia
Abbreviations CAP Community-acquired pneumonia COVID-19 Coronavirus disease-2019 SARS-CoV2 Coronavirus severe acute respiratory syndrome coronavirus 2
To the Editor: We read with interest the studies by Cariou et al [1] and Wang et al [2] published in the journal. Evidence so far suggests that type 2 diabetes mellitus may not increase the overall risk of an infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) [3], the causal agent of a syndrome called coronavirus disease2019 (COVID-19); however, pre-existing type 2 diabetes appears to be associated with more severe infection [4]. Moreover, recent evidence by Zhu et al [5] and data from an observational NHS England cohort [6, 7], consistently showed an increased risk for COVID-19-related death in patients with type 2 diabetes. The study by Cariou et al [1] adds to current knowledge by reporting that higher BMI (but not long-term glycaemic control or type of glucose-lowering therapy used) was significantly associated with the severity of COVID-19 infection as studied in their cohort of 1317 patients * Philipp M. Lepper [email protected] 1
Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, Kirrberger Strasse 100, 66421 Homburg/Saar, Germany
2
Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
3
Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
4
Nestlé Health Science, Vevey, Switzerland
with pre-existing diabetes (89% with type 2 diabetes). Wang and colleagues analysed whether blood glucose taken within 24 h of admission after a fasting period was a predictive marker for 28-day mortality in 605 COVID-19 patients without diabetes [2]. They found that patients with fasting serum glucose concentrations ≥7.0 mmol/l had a significantly higher risk of death (HR 2.30; 95% CI 1.49, 3.55; p = 0.0002). Hence, currently available evidence on clinical risk management in patients with COVID-19 strongly supports the inclusion of assessment of diabetes status as well as careful consideration of additional clinical attributes, such as BMI and blood glucose levels. These important insights may have just recently emerged for COVID-19; however, previous evidence in clinical community-acquired pneumonia (CAP) research has already identified the importance of pre-existing diabetes for outcome risk assessment. We conducted a large prospective study in 6891 Caucasian patients admitted for CAP due to causes other than SARS-CoV2 to 12 German centres [8]. We explored whether pre-existing diabet
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