Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study

Rait, Louise; Finnis, Mark; Douglas, James S.; Bhurani, Mansi; Broadley, Tessa; Trapani, Tony; Deane, Adam M.; Burrell, Aidan; Visser, Adam; Mattke, Adrian; Regli, Adrian; Rashid, Alan; Tabah, Alexis; Walker, Alison; Cheng, Allen; Corley, Amanda; Udy, Andrew; Ramnani, Anil; Eidan, Anthony; DeKeulenaer, Bart; Reddi, Benjamin; Richards, Brent; Knott, Cameron; Moore, C. L.; Delzoppo, Carmel; Boschert, Catherine; Tacon, Catherine; French, Craig; Austin, Danielle; Brewster, David C.; Cooper, David J.; Crosbie, David; Hawkins, David; Jessen, Edda; Martínez, Eduardo; Fysh, Edward; Litton, Edward; Oberender, Felix; McGain, Forbes; Salt, Gavin; Eastwood, Glenn M; Taori, Gopal; White, Hayden; Buscher, Hergen; Seppelt, Ian; Leditschke, I. Anne; Young, Janelle; Lavana, Jayshree; Cohen, Jérémy; Lugsdin, Jessica; Botha, John; Santamaria, John; Barrett, Jonathan; Singh, Kasha; Laupland, Kevin B.; El-Khawas, Khaled; Estensen, Kristine; Deshpande, Kush; White, Kyle; Fitzpatrick, Leigh; Campbell, Lewis; Ramanan, Mahesh; Saxena, Manoj; Kainer, Marion; Kol, Mark Kol; Page, Mark; Plummer, Mark P.; Štěrba, Martin; Anstey, Matthew H; Brain, Matthew J.; Maiden, Matthew J; Kilminster, Myrene; Hammond, Naomi; Bhadange, Neeraj; Humphreys, Nicole; Jain, Paras; Azzi, Paul; Secombe, Paul; Lister, Paula; Chan, Peter; McCanny, Peter; Britton, Phillip; Janin, Pierre; Krishnamurthy, Ravi; Sonawane, Ravikiran; Tiruvoipati, Ravindranath; Totaro, Richard; Bellomo, Rinaldo; Sanghavi, Ritesh; Bates, Samantha; Peake, Sandra; Bihari, Shailesh; George, Shane; Erickson, Simon; Webb, Steve; Arora, Subhash; Ganu, Subodh; Rozen, Thomas H; McKenna, Toni; Kadam, Umesh; Nayyar, Vineet; Choy, Wei Han; Al‐Bassam, Wisam

doi:10.1016/j.aucc.2022.05.002

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Clinical studies showed that diabetes in patients with COVID-19 disease is a risk factor for transfer to an intensive care unit and may be an independent factor for survival in SARS-CoV-2 viral infection [ 30 , 31 , 32 ]. In other studies, obesity in patients with SARS-CoV-2 viral infection was considered an independent risk factor for transfer to the intensive care unit [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Antidiabetic Treatment before Hospitalization and Admission Parameters in Patients with Type 2 Diabetes, Obesity, and SARS-CoV-2 Viral Infection

Restea

Mureşan

Voicu

et al. 2023

JPM

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Background: SARS-CoV-2 viral infection is a current and important topic for patients with comorbidities of type 2 diabetes and obesity, associated with increased risk of mortality and morbidity. This study aims to analyze, compare and describe admission parameters in patients with type 2 diabetes, obesity, and SARS-CoV-2 infection based on whether they received insulin therapy before hospital admission. Methods: Our study enrolled patients diagnosed with type 2 diabetes, obesity, and SARS-CoV-2 viral infection, 81 patients without insulin treatment before hospital admission, and 81 patients with insulin at “Gavril Curteanu” Municipal Clinical Hospital of Oradea, Romania, between August 2020 and March 2022. RT-PCR/rapid antigen tests were used for detecting SARS-CoV-2 viral infection. Results: The severe form of COVID-19 was found in 66% of all patients (65% in the group without insulin and 67% in the group with insulin). Oxygen saturation at the time of hospital admission was greater or equal to 90% in 62% of all patients. The most associated comorbidities we founded in this study were: hypertension in 75% of all patients (grade two hypertension 63% in the group without insulin and 64% in the group with insulin), ischemic heart disease in 35% of patients (25% in the group without insulin and 44% in the group with insulin, n = 0.008), heart failure in 9.3% of all patients (8.6% in the group without insulin and 10% in the group with insulin). CRP and procalcitonin are increased in both groups at hospital admission, with a slightly higher trend in the group with insulin therapy before hospital admission. We found that 56% of patients in the group with insulin treatment were with uncontrolled diabetes on admission. Only 10% of patients required a change in antidiabetic treatment with insulin therapy at discharge. In our study, 89% of all patients did not require short-term home oxygen therapy at discharge. Conclusions: Antidiabetic therapy taken before hospital admission did not protect patients against cytokine storm in COVID-19, but is very important in the pathophysiological stage of comorbidities. Paraclinical parameters at hospitalization showed differences in correlation with oral antidiabetic treatment like metformin or insulin therapy. Changing the antidiabetic treatment for a small percentage of patients in the group who had not been receiving insulin therapy before discharge was necessary. It is necessary for future studies to see all changes involved in antidiabetic treatment in patients with diabetes type 2 and obesity after SARS-CoV2 viral infection and its long-term evolution.

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Section: Discussionmentioning

confidence: 99%

Antidiabetic Treatment before Hospitalization and Admission Parameters in Patients with Type 2 Diabetes, Obesity, and SARS-CoV-2 Viral Infection

Restea

Mureşan

Voicu

et al. 2023

JPM

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“…Because the intravenous sedative drug propofol is a lipid emulsion, this may add an additional 20–30 kcal/h and risk administering excessive energy and/or insufficient protein 16 . In addition, the use of treatments such as dexamethasone will be synergistic with energy delivery to exacerbate hyperglycaemia 17 …”

Section: Introductionmentioning

confidence: 99%

Association between protocol change to a higher‐protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID‐19: A retrospective cohort study

Wittholz,

Hinckfus,

Karahalios

et al. 2024

J Parenter Enteral Nutr

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BackgroundGuidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID‐19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a “higher‐protein formula protocol” on protein, energy, and volume delivery when compared with standard nutrition protocol.MethodsThis was a retrospective cohort study of adult patients with COVID‐19 who received mechanical ventilation for >72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher‐protein formula protocol for patients with COVID‐19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered.ResultsThere were 114 participants (standard protocol, 48; higher‐protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (−0.02 to 0.18 g/kg/day), −1.71 kcal/kg/day (−3.64 to 0.21 kcal/kg/day) and −1.5 ml/kg/day (−2.9 to −0.1 ml/kg/day). Thirty‐three patients (standard protocol, 7; higher‐protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [−0.89 to 1.88 kcal/kg/day]).ConclusionImplementation of a higher‐protein formula protocol to patients with COVID‐19 modestly reduced volume administration without impacting protein and energy delivery.

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“…The coronavirus disease 2019 (COVID-19) is a life-threatening condition caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Since the beginning of the pandemic, diabetes mellitus (DM) emerged as a major comorbidity for COVID-19 severity and mortality [1][2][3][4][5][6][7]. Fortunately, the advent of SARS-CoV-2 vaccines reduced the incidence of COVID-19 post-acute sequelae and comorbidities [8,9].…”

Section: Introductionmentioning

confidence: 99%

Glycemic control predicts SARS-CoV-2 prognosis in diabetic subjects

et al. 2023

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Aim The coronavirus disease (COVID)‐19 incidence was higher in diabetes mellitus (DM), although several differences should be considered on the basis of characteristics of cohorts evaluated. This study was designed to evaluate the prevalence and potential consequences of COVID-19 in a large diabetic population in Northern Italy. Design Observational, longitudinal, retrospective, clinical study. Methods Subjects with both type 1 and type 2 DM living in the Province of Modena and submitted to at least one SARS-CoV-2 swab between March 2020 and March 2021 were included. Data were extracted from the Hospital data warehouse. Results 9553 diabetic subjects were enrolled (age 68.8 ± 14.1 years, diabetes duration 11.0 ± 6.9 years, glycated hemoglobin 57.2 ± 16.2 mmol/mol). COVID-19 was detected in 2302 patients (24.1%) with a death rate of 8.9%. The mean age and diabetes duration were significantly lower in infected versus non-infected patients. SARS-CoV-2 infection was more frequent in youngest people, according to quartile of age and retirement pension age of 65 years. No differences were detected considering sex. Higher HbA1c was detected in infected compared to non-infected patient. Death was predicted by diabetes duration and HbA1c. ROC analyses for death risk showed significant threshold for diabetes duration (10.9 years) and age (74.4 years). Conclusion In our cohort, SARS-CoV-2 infection correlates with age, diabetes duration and disease control. Diabetic patients with COVID-19 should be carefully followed when older than 74 years and with more than 10 years of DM duration. Supplementary Information The online version contains supplementary material available at 10.1007/s00592-023-02073-4.

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Diabetes mellitus, glycaemic control, and severe COVID-19 in the Australian critical care setting: A nested cohort study

Cited by 6 publications

References 26 publications

Antidiabetic Treatment before Hospitalization and Admission Parameters in Patients with Type 2 Diabetes, Obesity, and SARS-CoV-2 Viral Infection

Antidiabetic Treatment before Hospitalization and Admission Parameters in Patients with Type 2 Diabetes, Obesity, and SARS-CoV-2 Viral Infection

Association between protocol change to a higher‐protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID‐19: A retrospective cohort study

Glycemic control predicts SARS-CoV-2 prognosis in diabetic subjects

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