Association of Serum 1,5-Anhydroglucitol with Severe COVID-19 in T2D patients

Background: Hyperglycemia worsens the prognosis and severity in Covid-19 patients. Objective: To assess the impact of glycemic control on COVID-19 severity. Methods and Findings: Data from 460 individuals collected in Spain between April and July 2020 was analyzed in a cross-sectional study: healthy, Sars-Cov-2 negative (group 0, N = 197), Sars-Cov-2 positive, with mild COVID-19 symptoms (group 1, N = 113), Sars-Cov-2 positive, with severe COVID-19 symptoms who required hospitalization (group 2, N = 150) at Hospital Universitario Cruces in Bilbao, Spain. Fasting blood glucose, HbA1c and serum 1,5-anhydroglucitol (1,5-AG, indicator of hyperglycemic excursions over the prior 1-2 weeks) were measured. Differences in 1,5-AG (normal range >10µg/mL) were observed between all three groups (mean 1,5-AG of 21.19, 18.99, 14.64 µg/mL, respectively) when compared by an unpaired t-test. 1,5-AG levels across groups decreased with increasing severity, with the hospitalized patients (group 2) showing the greatest difference when compared to healthy individuals, p value < 0.0001. Logistic regression analysis showed that 1,5-AG had a mild positive association with increased COVID-19 severity (group 0 vs. group 2: AUC = 0.69, p value < 0.0001). A previous T2D diagnosis did not show association with COVID-19 severity (group 0 vs. group 2: AUC = 0.58, p value < 0.0001). Analysis of patients with a previous diagnosis of T2D showed a robust positive association between 1,5-AG and COVID-19 (group 0 vs. group 2, AUC = 0.79, p value 0.008). There was no association between HbA1c or fasting glucose with severity. Combination of 1,5-AG and HbA1c was similar than 1,5-AG alone (AUC = 0.80, p value 0.028). Conclusions: Glycemic fluctuations in T2D patients may contribute to severe COVID-19. Measurement of serum 1,5-AG in T2D patients might help clinicians quickly identify diabetes patients at risk of severe COVID-19. These patients may benefit from more intensive management, treatment and vaccine prioritization. Disclosure G. Sonia: None. L. Castano: None. E. A. Button: Employee; Self; Precision Diabetes, Inc. M. Zulueta: Employee; Self; Patia Europe. E. Arana: None. A. B. De la hoz: None. L. Mendizabal: Employee; Self; PATIA. J. Del olmo: None. R. Muñoz: None. L. Simon: Board Member; Self; Oncomatryx Biopharma, S. L, Patia Biopharma, SA de CV, Patia Europe S. L., Permedika Entrepeneurs, S. L, SunRock, S. L, Employee; Self; Oncomatryx Biopharma, S. L, Patia Biopharma, SA de CV, Patia Europe S. L., PatiaCan, SA de CV, Permedika Entrepeneurs, S. L, Other Relationship; Self; Oncomatryx Biopharma, S. L, Patia Biopharma, SA de CV, Quimatryx, S. L, Stock/Shareholder; Self; Helenes Ventures, S. L, Nelum, Corp, Oncomatryx Biopharma, S. L, Patia Biopharma, SA de CV, Patia Europe S. L., PatiaCan, SA de CV, Permedika Entrepeneurs, S. L, Stemcell Therapeutics, S. L, SunRock, S. L.