Glucocorticoid-Induced Hyperglycemia Including Dexamethasone-Associated Hyperglycemia in COVID-19 Infection: A Systematic Review

Brooks, Danielle; Schulman-Rosenbaum, Rifka; Griff, Megan; Lester, Janice; Wang, Cecilia C. Low

doi:10.1016/j.eprac.2022.07.014

Cited by 19 publications

(14 citation statements)

References 68 publications

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“…Furthermore, some medications can affect heart muscle function, e.g., corticosteroids affecting muscle metabolism and inflammation. Several studies have found a negative impact of long‐term high‐dose corticosteroid therapy during COVID‐19 on the occurrence of, among others, myocardial infarction, bacterial sepsis, cerebrovascular and ophthalmological diseases 44–47 . Similarly, Remdesivir potentially affects cardiac repolarisation 48 .…”

Section: Discussionmentioning

confidence: 99%

“…The authors did not consider the effect of drugs intake chronically or during and after infection, which may affect the occurrence and persistence of disorders in long-COVID. The examined patients were not hospitalized and did not take steroids or Remdesivir; this is particularly important due to the influence of corticosteroids [44][45][46][47] or Remdesivir 48 on heart muscle function. Another limitation is the lack of knowledge about whether patients had myocardial dysfunction before contracting COVID-19, as it had not been previously diagnosed.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

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Clinical and electrocardiographic correlates of myocardial dysfunction after COVID‐19 in nonhospitalised patients in long‐term follow‐up. Data from the polish long‐covid cardiovascular study

Kapusta,

Babicki,

Pieniawska‐Śmiech

et al. 2023

Journal of Medical Virology

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Clinical evidence indicates that COVID‐19 is a multiorgan disease that significantly impacts the cardiovascular system. However, little is known about the predictors of myocardial dysfunction after SARS‐CoV‐2 infection. Therefore, this research aimed to evaluate the clinical and electrocardiographic correlates of myocardial dysfunction after SARS‐CoV‐2 infection in nonhospitalised patients without previously diagnosed cardiovascular disease. This observational study included 448 patients selected from the database of 4142 patients in the Polish Long‐Covid Cardiovascular study. All patients underwent a 12‐lead electrocardiogram (ECG); 24‐h Holter ECG monitoring, 24/7 ambulatory blood pressure monitoring, echocardiography, and cardiac magnetic resonance imaging. According to the results of diagnostic tests, patients were divided into two groups depending on the occurrence of myocardial dysfunction after COVID‐19. Group 1–without myocardial dysfunction after COVID‐19–consisted of 419 patients, with a mean age of 48.82 (SD ± 11.91), and Group 2 (29 patients)–with myocardial dysfunction after COVID‐19, with a mean age of 51.45 (SD ± 12.92). When comparing the analysed groups, there were significantly more men in Group 2 (p = 0.006). QRS (corresponds to the time of ventricular contraction in an electrocardiographic examination) fragmentation (p = 0.031), arrhythmias (atrial fibrillation, supraventricular extrasystole, ventricular extrasystole) (p = 0.008), and male gender (p = 0.007) were independently associated with myocardial dysfunction after COVID‐19. The study showed that myocardial damage after COVID‐19 affects men more often and is independent of typical clinical factors and the severity of the disease course. The QRS fragmentation and arrhythmias observed in the ECG indicate the possibility of myocardial dysfunction in patients after COVID‐19, which may be a valuable marker for physicians.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID‐19 in nonhospitalised patients in long‐term follow‐up. Data from the polish long‐covid cardiovascular study

Kapusta,

Babicki,

Pieniawska‐Śmiech

et al. 2023

Journal of Medical Virology

View full text Add to dashboard Cite

show abstract

“…A recent systematic review stated that no standardized treatment guidelines exist for glucocorticoid‐induced hyperglycemia in COVID‐19. 34 As such, further investigation is needed to examine the achievement of the lower BG target by the artificial pancreas. In addition, BG management in an isolated area is a heavy burden for medical staff, and hand‐off of continuous BG monitoring using a subcutaneous sensor has been reported to reduce the burden on ICU staff.…”

Section: Discussionmentioning

confidence: 99%

“…We found that even if the BG target of the artificial pancreas was set at a lower level, better BG control was highly likely to be achieved. A recent systematic review stated that no standardized treatment guidelines exist for glucocorticoid‐induced hyperglycemia in COVID‐19 34 . As such, further investigation is needed to examine the achievement of the lower BG target by the artificial pancreas.…”

Section: Discussionmentioning

confidence: 99%

Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia

et al. 2022

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Background Many patients with severe coronavirus disease 2019 (COVID‐19) pneumonia experience hyperglycemia. It is often difficult to control blood glucose (BG) levels in such patients using standard intravenous insulin infusion therapy. Therefore, we used an artificial pancreas. This study aimed to compare the BG status of the artificial pancreas with that of standard therapy. Methods Fifteen patients were included in the study. BG values and the infusion speed of insulin and glucose by the artificial pancreas were collected. Arterial BG and administration rates of insulin, parenteral sugar, and enteral sugar were recorded during the artificial pancreas and standard therapy. The target BG level was 200 mg/dl. Results Arterial BG was highly correlated with BG data from the artificial pancreas. A higher BG slightly increased the difference between the BG data from the artificial pancreas and arterial BS. No significant difference in arterial BG was observed between the artificial pancreas and standard therapy. However, the standard deviation with the artificial pancreas was smaller than that under standard therapy ( p < 0.0001). More points within the target BG range were achieved with the artificial pancreas (180–220 mg/dl) than under standard therapy. The hyperglycemic index of the artificial pancreas (8.7 ± 15.6 mg/dl) was lower than that of standard therapy (16.0 ± 21.5 mg/dl) ( p = 0.0387). No incidence of hypoglycemia occurred under the artificial pancreas. Conclusions The rate of achieving target BG was higher using artificial pancreas than with standard therapy. An artificial pancreas helps to control BG in critically ill patients.

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“…Hyperglycemia is an independent factor associated with a severe prognosis in individuals hospitalized for COVID-19 [ 92 ]. Hyperglycemia may rely on stress, inflammation, and disruption of beta cells, as well as steroid administration [ 93 ]. Hyperglycemia negatively impacts innate cell-mediated immunity [ 91 ] and perturbs the antiviral response by suppressing Th1/Th17 cell activation, inducing oxidative stress, and causing endothelial dysfunction [ 94 ].…”

Section: Diabetes and Sars-cov-2 Infectionmentioning

confidence: 99%

Insight on Infections in Diabetic Setting

et al. 2023

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The correlation between diabetes mellitus and infectious diseases is widely recognized. DM patients are characterized by the impaired function of the immune system. This translates into the occurrence of a variety of infections, including urinary tract, skin and surgical site infections, pneumonia, tuberculosis, and, more recently, SARS-CoV-2. Hyperglycemia has been identified as a relevant factor contributing to unfavorable outcomes in hospitalized patients including SARS-CoV-2 patients. Several studies have been performed proving that to maintain the proper and stringent monitoring of glycemia, a balanced diet and physical activity is mandatory to reduce the risk of infections and their associated complications. This review is focused on the mechanisms accounting for the increased susceptibility of DM patients to infections, with particular attention to the impact of newly introduced hypoglycemic drugs in sepsis management.

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Glucocorticoid-Induced Hyperglycemia Including Dexamethasone-Associated Hyperglycemia in COVID-19 Infection: A Systematic Review

Cited by 19 publications

References 68 publications

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID‐19 in nonhospitalised patients in long‐term follow‐up. Data from the polish long‐covid cardiovascular study

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID‐19 in nonhospitalised patients in long‐term follow‐up. Data from the polish long‐covid cardiovascular study

Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia

Insight on Infections in Diabetic Setting

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