Diabetes is one of the most relevant comorbidities in worsening the prognosis of COVID-19. Recent studies show that hyperglycemia, in both people with or without diabetes, is an important risk factor for COVID-19-related mortality. 

In summary, evidence shows that: 

1. Hyperglycemia in people with diabetes at the time of hospital admission is more relevant as a risk factor than the previous glycemic control evaluated by HbA1c.
2. HbA1 before hospital admission may also play a role.
3. Hyperglycemia at the admission in hospital seems to worsen the prognosis of COVID-19 more in people without diabetes than in people with diabetes. 
4. Glucose variability during hospitalization, in both diabetes and non-diabetes, also emerged as an independent risk factor for a worse prognosis in COVID-19.

According to this evidence, it is clear that acute hyperglycemia has a key role as an independent risk factor in COVID-19. This evidence has garnered great interest, being considered somewhat of a new finding. 

It has also been reported that acute hyperglycemia occurs in about 50% of patients hospitalized for COVID-19, while the prevalence of diabetes in the same population was about 7%. A possible hypothesis is that the “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” may affect the pancreatic β-cells producing a reduction of insulin secretion. At the same time, the infection is also accompanied by a huge production of cytokines, which may induce insulin resistance. Both, reduced insulin secretion and insulin resistance, may hesitate in hyperglycaemia.

Moreover, recent data have shown that glycemic control may influence the efficacy of vaccination in people with diabetes.

The effect of acute hyperglycemia among COVID-19 patients is not unexpected and should be treated according to the already existing guidelines.

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