Diabetes Metab J > Volume 44(4); 2020 > Article
Chung, Ahn, and Moon: Response: The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study (Diabetes Metab J 2020;44:405-13)
We appreciate Dr. Kim and Professor Kim for their interest and comments on our article entitled “The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study” published in Diabetes & Metabolism Journal [1].
South Korea experienced a massive outbreak of coronavirus disease 2019 (COVID-19) in February 2020; 52% of all confirmed cases and 66% of deaths occurred in Daegu City [2]. According to the data published to date, COVID-19 fatalities were prevalent in patients with comorbid diabetes; however, whether diabetes is a risk factor for death remains unclear [3,4,5]. Diabetes was shown as an independent risk factor for severe and critical outcomes (composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality) in COVID-19 patients after adjusting for other risk factors.
Among patients with diabetes, old age significantly increased the risk of severe and critical outcomes; however, glycosylated hemoglobin (HbA1c) and serum glucose levels did not. Long-term glycemic control (HbA1c) has not been identified as a significant predictor of COVID-19 prognosis and death [6]; however, well-controlled blood glucose (≤180 mg/dL) during hospitalization resulted in a better outcome [7]. Regardless of HbA1c level, proper blood glucose control during hospitalization (140 to 180 mg/dL) might improve the prognosis of COVID-19 [8].
Contrary to concerns, anti-hyperglycemic agents or renin-angiotensin system (RAS) inhibitors did not significantly affect the severity of COVID-19. To date, whether RAS inhibitors affect the prognosis of COVID-19 is unclear, and dipeptidyl peptidase-4 inhibitors showed a neutral effect [6,9]. In our opinion, the existing drugs should be continued for mild to moderate COVID-19 patients, and in severe patients, insulin is most suitable for glycemic control [10].
Finally, we thank the editor-in-chief of the Diabetes & Metabolism Journal and all the readers who showed interest in our research.


CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.


1. Chung SM, Lee YY, Ha E, Yoon JS, Won KC, Lee HW, Hur J, Hong KS, Jang JG, Jin HJ, Choi EY, Shin KC, Chung JH, Lee KH, Ahn JH, Moon JS. The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study. Diabetes Metab J 2020;44:405-413.
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8. Kim MK, Ko SH, Kim BY, Kang ES, Noh J, Kim SK, Park SO, Hur KY, Chon S, Moon MK, Kim NH, Kim SY, Rhee SY, Lee KW, Kim JH, Rhee EJ, Chun S, Yu SH, Kim DJ, Kwon HS, Park KS. Committee of Clinical Practice Guidelines, Korean Diabetes Association. 2019 Clinical practice guidelines for type 2 diabetes mellitus in Korea. Diabetes Metab J 2019;43:398-406.
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10. Noh J, Chang HH, Jeong IK, Yoon KH. Coronavirus disease 2019 and diabetes: the epidemic and the Korean Diabetes Association perspective. Diabetes Metab J 2020;44:372-381.

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