A moderately higher time-in-range threshold improves the prognosis of type-2 diabetes patients complicated with COVID-19

Abstract

Abstract After fully lifting coronavirus disease 2019 (COVID-19) pandemic control measures in mainland China in 12/2022, the incidence of COVID-19 has increased markedly, making it difficult to meet the general time-in-range (TIR) requirement. We investigated a more clinically practical TIR threshold and examined its association with the prognosis of COVID-19 patients with type-2 diabetes. Sixty-three type-2 diabetes patients complicated with COVID-19 were evaluated. Patient information included epidemiological and laboratory characteristics, treatment options and outcomes. The percentages of time-above-range (TAR), time-below-range (TBR) and TIR were calculated from intermittently scanned continuous glucose monitoring. The composite end point included a >20-day length of stay, intensive care unit admission, mechanical ventilation use, or death. TIR with thresholds of 80 to 190 mg/dL was significantly associated with favorable outcomes. An increase of 1% in TIR is connected with a reduction of 3.70% in the risk of adverse outcomes. The Youden index was highest when the TIR was 54.73%, and the sensitivity and specificity were 58.30% and 77.80%, respectively. After accounting for confounding variables, our analysis revealed that threshold target ranges (TARs) ranging from 200 mg/dL to 230 mg/dL significantly augmented the likelihood of adverse outcomes.The TIR threshold of 80 to 190 mg/dL has a comparatively high predictive value of the prognosis of COVID-19. TIR >54.73% was associated with a decreased risk of adverse outcomes. These findings provide clinically critical insights into possible avenues to improve outcomes for COVID-19 patients with type-2 diabetes.