• Rahul D Barmanray, Joanna Y Gong, Mervyn Kyi, Dev Kevat, Mohammad A Islam, Anna Galligan, Georgina R Manos, Indu V Nair, Nayomi Perera, Nicholas K Adams, Ashvin Nursing, Annabelle M Warren, Peter S Hamblin, Richard J MacIsaac, Elif I Ekinci, Balasubramanian Krishnamurthy, Harin Karunajeewa, Kirsty Buising, Kumar Visvanathan, KayThomas W HTWHDepartment of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.St Vincent's Institute, Melbourne, Victoria, Australia., and Spiros Fourlanos.
• Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
• Intern Med J. 2023 Jan 1; 53 (1): 273627-36.

Background And AimsA relationship between diabetes, glucose and COVID-19 outcomes has been reported in international cohorts. This study aimed to assess the relationship between diabetes, hyperglycaemia and patient outcomes in those hospitalised with COVID-19 during the first year of the Victorian pandemic prior to novel variants and vaccinations.Design, SettingRetrospective cohort study from March to November 2020 across five public health services in Melbourne, Australia.ParticipantsAll consecutive adult patients admitted to acute wards of participating institutions during the study period with a diagnosis of COVID-19, comprising a large proportion of patients from residential care facilities and following dexamethasone becoming standard-of-care. Admissions in patients without known diabetes and without inpatient glucose testing were excluded.ResultsThe DINGO COVID-19 cohort comprised 840 admissions. In 438 admissions (52%), there was no known diabetes or in-hospital hyperglycaemia, in 298 (35%) patients had known diabetes, and in 104 (12%) patients had hyperglycaemia without known diabetes. ICU admission was more common in those with diabetes (20%) and hyperglycaemia without diabetes (49%) than those with neither (11%, P < 0.001 for all comparisons). Mortality was higher in those with diabetes (24%) than those without diabetes or hyperglycaemia (16%, P = 0.02) but no difference between those with in-hospital hyperglycaemia and either of the other groups. On multivariable analysis, hyperglycaemia was associated with increased ICU admission (adjusted odds ratio (aOR) 6.7, 95% confidence interval (95% CI) 4.0-12, P < 0.001) and longer length of stay (aOR 173, 95% CI 11-2793, P < 0.001), while diabetes was associated with reduced ICU admission (aOR 0.55, 95% CI 0.33-0.94, P = 0.03). Neither diabetes nor hyperglycaemia was independently associated with in-hospital mortality.ConclusionsDuring the first year of the COVID-19 pandemic, in-hospital hyperglycaemia and known diabetes were not associated with in-hospital mortality, contrasting with published international experiences. This likely mainly relates to hyperglycaemia indicating receipt of mortality-reducing dexamethasone therapy. These differences in published experiences underscore the importance of understanding population and clinical treatment factors affecting glycaemia and COVID-19 morbidity within both local and global contexts.© 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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