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Glycemic control and COVID-19 outcomes across the continuum of glucose regulation: a retrospective cohort study

Year: 2026

Type: article

Abstract: Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

Source: Frontiers in Clinical Diabetes and Healthcare

DOI: 10.3389/fcdhc.2026.1862850