Supplementary: Implications of a HbA1c based diabetes screening on prevalence and impact of dysglycemia in patients with COVID-19

<strong>Purpose:</strong> In patients with SARS-CoV-2 infection, diabetes is associated with poor COVID-19 prognosis. However, case detection strategy is divergent and reported prevalence varies from 5 to 35%. We examined in how far the choice of screening tools impacts the detection rate of dysglycemia and in consequence the estimation of diagnosis-associated risk for moderate (mo) or severe (s) COVID-19. <strong>Methods:</strong> Non-ICU in-patients with COVID-19 were screened systematically at admission for diabetes (D) and prediabetes (PreD) by HbA1c (A), random blood glucose (B) and known history (C) during 01/NOV/2020-08/MAR/2021. Dysglycemia rate and impact on COVID-19 outcome were analyzed in two screening strategies (ABC vs. BC). <strong>Results:</strong> 578/601 (96.2%) of admitted patients were screened and analyzed. In ABC, prevalence of D and PreD was 38.2 and 37.5%, respectively. D was significantly associated with an increased risk for more severe COVID-19 (aOR(moCOVID-19): 2.14, 95%CI: 1.22-3.75 and aOR(sCOVID-19): 2.83, 95%CI:1.54-5.19). Patients with PreD also presented more often with more severe COVID-19 than those with normoglycemia (aOR(moCOVID-19): 1.76, 95%CI: 1.04-2.97 and aOR(sCOVID-19): 2.41, 95%CI: 1.37-4.23). Screening with BC only failed to identify 96% of PreD (206/217) and 26.2% of D diagnosis (58/221) and missed association of dysglycemia and COVID-19 severity. <strong>Conclusions:</strong> Pandemic conditions may hamper dysglycemia detection rate and in consequence the awareness of individual patient risk for COVID-19 severity. A systematic diabetes screening including HbA1c reduces underdiagnosis of previously unknown or new onset dysglycemia, enhances the quality of risk estimation and access of patients at risk to a diabetes-specific intervention.

**研究目的**：在新型冠状病毒（SARS-CoV-2）感染患者中，糖尿病与新型冠状病毒肺炎（COVID-19）不良预后密切相关。但当前糖代谢异常（dysglycemia）的病例筛查策略并不统一，已报道的患病率波动于5%~35%。本研究旨在探讨筛查工具的选择对糖代谢异常检出率的影响，及其对中度（moderate，简写mo）、重度（severe，简写s）新型冠状病毒肺炎诊断相关风险评估的影响。**研究方法**：本研究于2020年11月1日至2021年3月8日期间，对非重症监护病房（non-ICU）收治的新型冠状病毒肺炎（COVID-19）住院患者，在入院时通过糖化血红蛋白（HbA1c，标记为A）、随机血糖（标记为B）及既往病史（标记为C）系统筛查糖尿病（标记为D）与糖尿病前期（prediabetes，标记为PreD）。本研究对比了两种筛查策略（ABC与BC）下的糖代谢异常检出率，及其对新型冠状病毒肺炎预后的影响。**研究结果**：本研究共纳入并分析了601例入院患者中的578例（96.2%）。在ABC筛查策略下，糖尿病与糖尿病前期的患病率分别为38.2%与37.5%。糖尿病患者发生更严重新型冠状病毒肺炎的风险显著升高（调整后比值比（adjusted Odds Ratio，aOR） 中度新型冠状病毒肺炎(moCOVID-19)：2.14，95%置信区间（95% Confidence Interval，95%CI）：1.22~3.75；调整后比值比（adjusted Odds Ratio，aOR） 重度新型冠状病毒肺炎(sCOVID-19)：2.83，95%置信区间（95% Confidence Interval，95%CI）：1.54~5.19）。糖尿病前期患者相较于血糖正常者，发生更严重新型冠状病毒肺炎的概率也显著更高（调整后比值比（adjusted Odds Ratio，aOR） 中度新型冠状病毒肺炎(moCOVID-19)：1.76，95%置信区间（95% Confidence Interval，95%CI）：1.04~2.97；调整后比值比（adjusted Odds Ratio，aOR） 重度新型冠状病毒肺炎(sCOVID-19)：2.41，95%置信区间（95% Confidence Interval，95%CI）：1.37~4.23）。仅采用BC策略筛查时，会漏诊96%的糖尿病前期患者（206/217）与26.2%的糖尿病患者（58/221），且无法检测到糖代谢异常与新型冠状病毒肺炎病情严重程度之间的关联。**研究结论**：新冠疫情期间的筛查条件可能会降低糖代谢异常的检出率，进而削弱对个体患者新型冠状病毒肺炎重症风险的识别能力。包含糖化血红蛋白（HbA1c）的系统性糖尿病筛查，可减少既往未确诊或新发糖代谢异常的漏诊率，提升风险评估的准确性，并使高危患者能够获得针对性的糖尿病干预措施。