Hypoglycemia at the time of Covid-19 pandemic

Abstract

Background: Hypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines. Aim: To assess the factors associated with the risk of hypoglycemia during AprileMay 2020 lockdown in people with type 2 diabetes mellitus. Methodology: We analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia. Results: The majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively. Conclusion: The COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.

The Optimal Medical Therapy for Glycemic Control in COVID-19

“…Sitagliptin use was significantly associated with reduction of mortality (HR, 0.44; 95% CI, 0.29 -0.66), with an improvement of COVID-19 (60% vs. 38%; P = 0.0001) as compared with patients on the standard care. Pioglitazone IL-6 expression was reduced by pioglitazone in monocytes, white adipose tissue and cardiomyocytes (Table 3 [2,[21][22][23][24]). Pioglitazone significantly reduced serum CRP levels.…”

“…Sulfonylurea increases secretion of insulin, anabolic hormone, which may be beneficial for the treatment of severe infection (Table 3 [2,[21][22][23][24]). However, sulfonylurea is likely to develop hypoglycemia.…”

“…Shah et al analyzed the data retrospectively from 146 patients of type 2 diabetes reporting to the emergency department during lockdown period with symptoms suggestive of hypoglycemia [24]. A combination of metformin and sulfonylureas was most commonly associated with the development of hypoglycemia (65.75%) in patients with type 2 diabetes during the COVID-19 lockdown [24].…”

“…A combination therapy of metformin and sulfonylureas was most commonly associated with the development of hypoglycemia (65.75%) [24].…”

Letter to the Editor: Do biomarkers of COVID-19 severity simply reflect a stress response in type 2 diabetes: Biomarker response to hypoglycemia

“…Case reports from Turkey demonstrated that 3 COVID-19 patients undergoing hemodialysis who were treated with hydroxychloroquine (HCQ) developed hypoglycemia after HCQ treatment for COVID-19 [ 5 ]. Moreover, an Indian study of patients with T2D revealed that the COVID-19 lockdown has been associated with increased risk of hypoglycemia in patients with T2DM, especially those receiving sulfonylureas (SU), insulin and/or HCQ, and especially in patients with associated co-morbidities [ 6 ] . Therefore, based on the above evidence, we hypothesized that an ‘induced hypoglycemic condition’ might be an ideal stress condition to elucidate the ‘immuno-biomarkers’ for severe outcome in COVID-19.…”