Characteristics, Management, and Outcomes of Elderly Patients With Diabetes in a COVID-19 Unit: Lessons Learned.

Abstract

BackgroundDiabetes may affect in-hospital mortality of patients with Coronavirus disease 2019 (COVID-19). We have retrospectively evaluated clinical characteristics, diabetes management, and outcomes in a sample of COVID-19 patients with diabetes admitted to our hospital. MethodsAll patients admitted to the Infectious Diseases Unit from March 28th, 2020, to June 16th, 2020, were enrolled. Clinical information and biochemical parameters were collected at the time of admission. Patients were ranked according to diabetes and death. ResultsSixty-one patients with COVID-19 were analyzed. Most of them were from a long-term health care facility. Mean age was 77±16 years, and 19 had type 2 diabetes (T2D). Eighteen patients died, including 8 with T2D and 10 without T2D (p=0.15). Patients with diabetes were significantly older, had a higher prevalence of cardiovascular diseases, and a significantly lower lymphocyte count. No significant relationship was found between diabetes and in-hospital mortality [OR 2.3; CI 0.73-7.38, p=0.15]. Patients with diabetes were treated with insulin algorithm titration algorithm, with no severe hypoglycemic events, ketoacidosis and hyperosmolar hyperglycemias occurring during hospitalization. Mean fasting pre-meal capillary blood glucose was 157±45 mg/dL, and the coefficient of variation of glycaemia was 29%. ConclusionsOur study, albeit limited by the small number of subjects, did not describe any significant association between T2D diabetes and mortality. Clinical characteristics of patients, and acceptable glucose control prior and during hospitalization may have influenced the result, thus suggesting that the insulin algorithm titration algorithm applied should be validated.

COVID-19 and diabetes—Two giants colliding: From pathophysiology to management

“…-T2DM treated with insulin had a decreased risk of COVID-19 infection requiring hospitalization (85) Multi-injection insulin therapy or continuous intravenous infusion by a syringe pump in acutely serious hospitalized patients with COVID-19 (116) ACE2, angiotensin-converting enzyme 2; COVID-19, coronavirus disease 2019; DM, diabetes mellitus; mTOR, mammalian target of rapamycin; ROS, reactive oxygen species; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF-a, tumor necrosis factor alpha.…”

“…Some evidence has demonstrated that patients with severe COVID-19 and DM have a higher insulin requirement (92,93), which may be explained by the dysfunction of beta-cells or the high inflammatory process induced by the virus. For these reasons, the best therapeutic choice for these patients is multi-injection insulin therapy or continuous intravenous infusion by syringe pump (116) with adequate enteral nutrition or regular oral food intake. Importantly, the use of insulin has some disadvantages, among which is the need to closely monitor the patient's glucose levels to avoid hypoglycemia (132,133).…”