Dysglycemia in COVID-19 and Type 2 Diabetes Mellitus: Peculiarities of the Glycemic Profile in Hospitalized Patients and the Role of Steroid-Induced Disorders

Abstract

BACKGROUND: There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM).AIM: to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment.MATERIALS AND METHODS: We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 without COVID-19 (control group) using a professional 4–7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS.RESULTS: Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range» (32.7 ± 20.40 vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods.CONCLUSION: Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5–6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.

Factors affecting the severity of COVID-19 and the development of complications

“…Dexamethasone treatment results in the most pronounced hyperglycemia without any episodes of hypoglycemia. Even if a patient with comorbidities is stable after completing glucocorticoid treatment, it is advisable to recommend blood glucose testing at least 5-6 times a day, including mandatory monitoring during nighttime [71].…”

Association of COVID-19 Infection With Incident Diabetes

“…Among other long-term sequelae of SARS-CoV-2 infection, emerging evidence suggests that COVID-19 may be associated with changes in the pathophysiology of diabetes . Diabetes has already been established as a risk factor associated with more severe COVID-19 respiratory outcomes, and SARS-CoV-2 infection was associated with the worsening of preexisting diabetes symptoms . However, it is not fully known if SARS-CoV-2 infection is associated with transient hyperglycemia during active infection or if metabolic alterations persist, associated with increased risk of subsequent diabetes among individuals with infections.…”