Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis

Kapoor, Rajat; Timsina, Lava; Gupta, Nupur; Kaur, Harleen; Vidger, Arianna; Pollander, Abby; Jacobi, Judith; Khare, Swapnil; Rahman, Omar

doi:10.3390/jcm9113635

Cited by 17 publications

(22 citation statements)

References 42 publications

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“…Our findings are complementary to a recent analysis that examined time in target glucose range in patients admitted to ICU with COVID‐19. The authors found that ventilator use, neuromuscular blockade and use of high‐flow nasal oxygen all predicted poor glycaemic control 8 . Interestingly, this study compared glycaemia and insulin requirements in 93 COVID‐19 patients to all ( N = 469) contemporaneous ICU admissions (for any reason) without COVID‐19 and found that COVID‐19 patients had poorer glycaemic control and higher insulin requirements.…”

Section: Discussionmentioning

confidence: 87%

“…The authors found that ventilator use, neuromuscular blockade and use of high-flow nasal oxygen all predicted poor glycaemic control. 8 Interestingly, this study compared glycaemia and insulin requirements in 93 COVID-19 patients to all (N = 469) contemporaneous ICU admissions (for any reason) without COVID-19 and found that COVID-19 patients had poorer glycaemic control and higher insulin requirements. However, the COVID-19 group required much more respiratory support compared to the non-COVID-19 group and the authors did not make any attempt to adjust for this difference.…”

Section: Diabetes Therapies Used In Patients With Covid-19 and Non-mentioning

confidence: 97%

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The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

Lockhart

Griffiths

Petrisor

et al. 2021

Endocrino Diabet & Metabol

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There is emerging interest in the effect of COVID-19 on glucose homeostasis, with some suggesting that COVID-19 may be a uniquely diabetogenic virus. 1 Observations advanced to support this hypothesis include anecdotal reports of high insulin requirements in patients with severe COVID-19. [2][3][4] However, to date there has been no longitudinal study of patients with COVID-19 to empirically assess insulin requirements. We sought to address this deficiency by comparing insulin requirements in patients admitted to intensive care with severe COVID-19 to a historical control group with severe non-COVID-19 viral pneumonitis.

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Section: Discussionmentioning

confidence: 87%

Section: Diabetes Therapies Used In Patients With Covid-19 and Non-mentioning

confidence: 97%

The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

Lockhart

Griffiths

Petrisor

et al. 2021

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

show abstract

“…44 In the same vein, a study on ICU patients showed that the less time spent in Open access range was associated with increased utilisation of a ventilator, prolonged mechanical ventilation and increased mortality. 45 Most importantly, a spline analysis of glucose levels in patients with DM with continuous glucose monitoring showed a non-linear relationship between time spent above range and glycaemic variability with the increased likelihood of composite adverse COVID-19 outcomes (need for ICU admission, mechanical ventilation or critical illness). 46…”

Section: Open Accessmentioning

confidence: 99%

“…This also prevented the analysis of time in range or BG variability, both being linked to increased severity, case fatality and poor COVID-19 outcomes. [42][43][44][45][46] Lastly, the study period coincides with the height of the first pandemic wave in Spain, when there was a shortage of ventilators and intensive care beds. At this point, age was the deciding factor for whether or not someone received potentially lifesaving ICU care.…”

Section: Limitations Of This Studymentioning

confidence: 99%

Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

et al. 2021

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AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

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“…In the analysis of 562 ICU patients, the time in range (TIR) (70 -150 mg/dL) and the daily insulin dose in critical COVID-19 patients and non-COVID-19 patients were investigated [32]. The TIR in COVID-19 patients (44.4%) was significantly lower than non-COVID-19 patients (68.5%).…”

Section: Insulin Therapy In Glycemic Control Among Covid-19 Patientsmentioning

confidence: 99%

The Optimal Medical Therapy for Glycemic Control in COVID-19

Yanai

2021

J Endocrinol Metab

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Diabetes is highly linked to the severity of coronavirus disease 2019 (COVID-19). My recent meta-analysis also suggested a higher prevalence of diabetes in severe COVID-19 as compared with non-severe COVID-19. Recent observational studies have shown that hyperglycemia was significantly associated with severity of COVID-19 in both diabetic and non-diabetic patients. To prevent worse outcome of COVID-19, more tight glucose control is required. I studied the association between hyperglycemia and worse outcome of COVID-19, the putative beneficial and harmful effects, and clinical outcomes of oral hypoglycemic drugs and insulin use in glycemic control among COVID-19 patients, by searching literatures. Although there were some negative studies, the meta-analysis reported that the treatment using metformin was associated with reduction in mortality due to COVID-19. One study showed that treatment with sitagliptin, one of dipeptidyl peptidase-4 (DPP4) inhibitors, during hospitalization was associated with reduction of mortality, with a clinical improvement as compared with patients on the standard care. There were no clinical studies showed effects of glucagon-like peptide-1 receptor agonists, pioglitazone and sulfonylurea on COVID-19 outcomes. Regarding sodium-glucose cotransporter 2 (SGLT2) inhibitors, a case of euglycemic diabetic ketoacidosis (DKA) associated with COVID-19 and a case of DKA that was difficult to distinguish from COVID-19 were reported. COVID-19 patients who need hospital care may deteriorate rapidly, an early and appropriate initiation of insulin therapy in hyperglycemic COVID-19 patients may be to be encouraged.

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Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis

Cited by 17 publications

References 42 publications

The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

The Optimal Medical Therapy for Glycemic Control in COVID-19

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