Incidence and control of steroid-induced hyperglycaemia in hospitalised patients at a tertiary care centre for lung diseases

The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes

PURPOSE

This study investigated: (1) the type of corticosteroid associated with the greatest degree of hyperglycemia, assessed using bedside capillary blood glucose monitoring, in hospitalized patients; and (2) the pattern of hyperglycemia throughout the day with the use of each type of corticosteroid.

METHODS

This single-center, retrospective study used data from 964 adult inpatients receiving oral or IV corticosteroids. Data on capillary blood glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to investigate changes in glucose concentration over time with the use of four different corticosteroids. An autoregressive covariance structure was used to model correlations between repeated measurements.

FINDINGS

Across all 7 days, the mean blood glucose concentration was greater with dexamethasone compared to that with hydrocortisone (mean difference, 16.6 mg/dL [95% CI, 8.1-24.8] [0.92 mmol/L (95% CI, 0.45-1.38)]) or prednisolone (mean difference, 20.0 mg/dL [95% CI, 14.2-25.7] [1.11 mmol/L (95% CI, 0.79-1.43)]). The mean blood glucose concentration was greater with methylprednisolone compared to that with hydrocortisone (mean difference, 23.9 mg/dL [95% CI, 11.3-36.4] [1.33 mmol/L (95% CI, 0.63-2.02)]), and with methylprednisolone versus prednisolone (mean difference, 27.4 mg/dL [95% CI, 16.4-38.3] [1.52 mmol/L (95% CI, 0.91-2.13)]). There were no significant differences in the patterns of hyperglycemia at six time points of the day with each type of corticosteroid.

IMPLICATIONS

Treatment with oral or IV dexamethasone or methylprednisolone was associated with greater hyperglycemia in comparison to prednisolone and hydrocortisone. More vigorous monitoring and intervention, when necessary, are suggested in adult inpatients receiving corticosteroids, in particular dexamethasone and methylprednisolone.

Combination therapy with predicted body weight-based dexamethasone, remdesivir, and baricitinib in patients with COVID-19 pneumonia: A single-center retrospective cohort study during 5th wave in Japan

BACKGROUND

Dexamethasone, remdesivir, and baricitinib reduce mortality in patients with coronavirus disease 2019 (COVID-19). A single-arm study using combination therapy with all three drugs reported low mortality in patients with severe COVID-19. In this clinical setting, whether dexamethasone administered as a fixed dose of 6 mg has sufficient inflammatory modulation effects of reducing lung injury has been debated.

METHODS

This single-center retrospective study was conducted to compare the treatment strategies/management in different time periods. A total of 152 patients admitted with COVID-19 pneumonia who required oxygen therapy were included in this study. A predicted body weight (PBW)-based dose of dexamethasone with remdesivir and baricitinib was administered between May and June 2021. After this period, patients were administered a fixed dose of dexamethasone at 6.6 mg/day between July and August 2021. The additional respiratory support frequency of high-flow nasal cannula, noninvasive ventilation, and mechanical ventilation was analyzed. Moreover, the Kaplan-Meier method was used to analyze the duration of oxygen therapy and the 30-day discharge alive rate, and they were compared using the log-rank test.

RESULTS

Intervention and prognostic comparisons were performed in 64 patients with PBW-based and 88 with fixed-dose groups. The frequency of infection or additional respiratory support did not differ statistically. The cumulative incidence of being discharged alive or oxygen-free rate within 30 days did not differ between the groups.

CONCLUSIONS

In patients with COVID-19 pneumonia who required oxygen therapy, combination therapy with PBW-based dexamethasone, remdesivir, and baricitinib might not shorten the hospital stay's length or oxygen therapy's duration.

Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia

AIMS

The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia.

METHODS

In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed.

RESULTS

The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r² = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r² = 0.65, p < 0.001).

CONCLUSIONS

In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.

Сarbohydrate metabolism disorders and their outcomes in the long-term period in hospitalized patients with COVID-19

BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients.

AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it.

MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose; HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters.

RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of  carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%); 8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people).

CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.