Lopez-Huamanrayme E, Garate-Chirinos DD, Espinoza-Morales F, Del-Castillo-Ochoa S, Gomez-Noronha A, Salsavilca-Macavilca E, Taype-Rondan A, Pasquel FJ. Association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital: A retrospective cohort study.
J Clin Transl Endocrinol 2021;
26:100265. [PMID:
34567978 PMCID:
PMC8455160 DOI:
10.1016/j.jcte.2021.100265]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
Very limited information about inpatient glycemic control or anti-hyperglycemic treatment strategies is available from low- and middle-income countries, such as Peru.
We observed a high mortality (39,1%) among patients with diabetes and COVID-19 in a Peruvian hospital. After admission, sliding scale insulin therapy was the most common treatment approach for hospitalized patients with diabetes and COVID-19.
Early and continuous use of sliding scale insulin alone was associated with higher mortality compared to fixed-dose insulin regimens.
In the context of COVID-19 pandemic, the use of the sliding scale insulin alone is frequent and its early and continuous use may be associated with higher in-hospital mortality, its use should be discouraged. Fixed-dose insulin is recommended, after an individualized evaluation.
Objective
To evaluate the association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital.
Methods
A retrospective cohort study was conducted between March and July 2020. Individual-level data were extracted from an implemented virtual platform. We included patients with type 2 diabetes hospitalized with COVID-19. The assessed outcome was in-hospital mortality. The Independent variable of interest was hyperglycemic treatment. We used Poisson regressions with robust variance to obtain crude and adjusted relative risks (RR) and their 95% confidence intervals (95% CI).
Results
Out of 1635 patients hospitalized for COVID-19 during the study period, 248 patients with diabetes mellitus were included. The majority were men (66.9%), the median age was 62 years. Ninety-seven patients died in the hospital (39.1%). The median glycemia on admission was 222.5 mg/dL. At 48 h after hospital admission, 125 patients (50.4%) received sliding scale insulin alone (SSI), 46 (18.5%) received a fixed-dose insulin regimen. In the adjusted analysis, the group with SSI at 48 h of hospitalization had higher mortality than those with fixed-dose insulin (adjusted RR: 1.69; 95% CI: 1.01 – 2.83), and those and who continued with SSI in the following days had higher mortality compared to the group that switched to fixed-dose insulin (adjusted RR: 1.64; 95% CI: 1.17 – 2.32).
Conclusion
Among assessed patients with diabetes and COVID-19, more than a third died during hospitalization. Early and continuous use of the sliding scale was associated with higher mortality compared to fixed-dose insulin regimens.
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