Skip to main content Skip to main navigation menu Skip to site footer

Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus


Objective: This systematic review determined the role of HbA1c in the progression and prognosis of COVID-19 in patients with diabetes mellitus from several previously published articles.

Method: We searched from an open-access database according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICO criteria. The inclusion criteria for the article search included: 1) COVID-19 patients with diabetes mellitus; 2) full articles; 3) English articles; 4) article publication time range from 2016 to 2021. Quality assessment for each article is evaluated using a checklist from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Result: We obtained two cohort studies and four cross-sectional studies of all the articles reviewed from 2019-2021. All studies evaluated the role of HbA1c in the progression, prognosis, and mortality of COVID-19 patients with diabetes mellitus. Most of the reported studies showed an association between elevated HbA1c and worsening of the COVID-19 disease prognosis. The association was assessed by the patient's clinical deterioration included lower oxygen saturation, increased NLR (neutrophil-lymphocyte ratio), the tendency to lymphopenia, improved renal function, increased ICU admission, and mechanical ventilation and increased ventilation mortality.

Conclusion: A high HbA1c was closely related to a worse COVID-19 prognosis in clinical development and mortality. We found the potential for developing a scoring system to predict the worsening and mortality of COVID-19 and improve the quality of prevention and management of COVID-19, especially in patients with diabetes mellitus.


Tujuan: mengkaji peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus dari beberapa literatur yang telah dipublikasi sebelumnya.

Metode: Pencarian literatur secara sistematis dilakukan pada basis data dengan akses terbuka sesuai dengan pedoman PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) dan kriteria PICO. Kriteria inklusi pencarian artikel antara lain: 1) pasien COVID-19 dengan diabetes mellitus; 2) artikel lengkap; 3) artikel berbahasa Inggris; 4) rentang waktu terbit artikel dari tahun 2016 hingga tahun 2021. Penilaian kualitas pada setiap artikel yang dievaluasi menggunakan checklist dari Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Hasil: Dari seluruh artikel yang dikaji dari tahun 2019-2021, didapatkan 2 studi kohort dan 4 studi potong lintang. Keseluruhan studi mengevaluasi peran HbA1c dalam progresi, prognosis, maupun mortalitas pada pasien COVID-19 dengan diabetes mellitus. Sebagian besar penelitian yang dilaporkan menunjukkan keterkaitan antara peningkatan HbA1c dan perburukan prognosis penyakit COVID-19 yang dinilai dari perburukan klinis pasien yaitu saturasi oksigen yang lebih rendah, meningkatnya NLR (neutrophil lymphocyte ratio), kecenderungan limfopenia, fungsi ginjal yang meningkat, peningkatan admisi ICU dan pemanfaatan ventilator mekanik serta meningkatnya mortalitas.

Simpulan: HbA1c yang tinggi terbukti berhubungan erat dengan prognosis COVID-19 yang lebih buruk ditinjau dari perkembangan klinis hingga tingkat mortalitas yang terjadi. Hal ini menunjukkan potensi berkembangnya sistem skoring untuk memprediksi perburukan dan mortalitas COVID-19 serta peningkatan kualitas pencegahan dan tatalaksana COVID-19 terutama pada pasien diabetes mellitus.


  1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/s0140-6736(20)30183-5
  2. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/nejmoa2002032
  3. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA. 2020;323(13):1239. doi:10.1001/jama.2020.2648
  4. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/s0140-6736(20)30211-7
  5. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. doi:10.1001/jama.2020.1585
  6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/s0140-6736(20)30566-3
  7. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):303-310. doi:10.1016/j.dsx.2020.04.004
  8. Yang JK, Feng Y, Yuan MY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23(6):623-628. doi:10.1111/j.1464-5491.2006.01861.x
  9. Al-Tawfiq JA, Hinedi K, Ghandour J, et al. Middle East Respiratory Syndrome Coronavirus: A Case-Control Study of Hospitalized Patients. Clin Infect Dis. 2014;59(2):160-165. doi:10.1093/cid/ciu226
  10. Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID ?19. Diabetes Metab Res Rev. 2020;36(7). doi:10.1002/dmrr.3319
  11. Huang R, Zhu L, Xue L, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrospective, multi-center study. PLoS Negl Trop Dis. 2020;14(5):e0008280. doi:10.1371/journal.pntd.0008280
  12. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol. 2020;127:104354. doi:10.1016/j.jcv.2020.104354
  13. Maddaloni E, Buzzetti R. Covid?19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020;36(7). doi:10.1002/dmrr.3321
  14. Delamaire M, Maugendre D, Moreno M, Le Goff M-C, Allannic H, Genetet B. Impaired Leucocyte Functions in Diabetic Patients. Diabet Med. 1997;14(1):29-34. doi:10.1002/(sici)1096-9136(199701)14:1<29::aid-dia300>;2-v
  15. Shah BR, Hux JE. Quantifying the Risk of Infectious Diseases for People With Diabetes. Diabetes Care. 2003;26(2):510-513. doi:10.2337/diacare.26.2.510
  16. Nalysnyk L, Hernandez-Medina M, Krishnarajah G. Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes, Obes Metab. 2010;12(4):288-298. doi:10.1111/j.1463-1326.2009.01160.x
  17. Liu L, Wei W, Yang K, et al. Glycemic control before admission is an important determinant of prognosis in patients with coronavirus disease 2019. J Diabetes Investig. Published online 2020:1-10. doi:10.1111/jdi.13431
  18. Liu Z, Bai X, Han X, et al. The association of diabetes and the prognosis of COVID-19 patients: A retrospective study. Diabetes Res Clin Pract. 2020;169:108386. doi:10.1016/j.diabres.2020.108386
  19. Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020;63(8):1500-1515. doi:10.1007/s00125-020-05180-x
  20. Wang Z, Du Z, Zhu F. Glycosylated hemoglobin is associated with systemic inflammation, hypercoagulability, and prognosis of COVID-19 patients. Diabetes Res Clin Pract. 2020;164:108214. doi:10.1016/j.diabres.2020.108214
  21. Lu X, Cui Z, Pan F, et al. Glycemic status affects the severity of coronavirus disease 2019 in patients with diabetes mellitus: an observational study of CT radiological manifestations using an artificial intelligence algorithm. Acta Diabetol. 2021;58(5):575-586. doi:10.1007/s00592-020-01654-x
  22. Liu Y, Lu R, Wang J, et al. Diabetes, even newly defined by HbA1c testing, is associated with an increased risk of in-hospital death in adults with COVID-19. BMC Endocr Disord. 2021;21(1):1-10. doi:10.1186/s12902-021-00717-6
  23. Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta diabetologica. 2010 Sep 1;47(3):193-9.
  24. Kulcsar KA, Coleman CM, Beck SE, Frieman MB.Comorbid diabetes results in immune dysregulation and enhanced dis- ease severity following MERS-CoV infection. JCI Insight. 2019. https ://
  25. Philips BJ, Meguer JX, Redman J, Baker EH. Factors determining the appearance of glucose in upper and lower respiratory tract secretions. Intensive Care Med 2003;29(12):2204–2210.
  26. Fuso L, Pitocco D, Antonelli-Incalzi R. Diabetic lung, an underrated complication from restrictive functional pattern to pul- monary hypertension. Diabetes Metab Res Rev 2009;35(6):e3159. https ://
  27. Jaeckel E, Manns M, Von Herrath M. Viruses and diabetes. Ann N Y Acad Sci 2002;958:7–25.
  28. Roivainen M, Rasilainen S, Ylipaasto P, et al. Mechanisms of coxsackievirus-induced damage to human pancreatic beta- cells. J Clin Endocrinol Metab 2000;85(1):432–40.
  29. Yao XH, Li TY, He ZC, et al. A pathological report of three COVID-19 cases by minimally invasive autopsies. Zhonghua Bing Li Xue Za Zhi 2020;49:E009.
  30. Emanuela F, Grazia M, Marco de R, Maria Paola L, Giorgio F, Marco B. Inflammation as a link between obesity and metabolic syndrome. J Nutr Metab 2012;2012 476380.

How to Cite

Praptika, N. L. P., & Karya, K. W. S. (2021). Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus. Intisari Sains Medis, 12(3), 682–688.




Search Panel

Ni Luh Parameswari Praptika
Google Scholar
ISM Journal

Kadek Wisnu Segara Karya
Google Scholar
ISM Journal