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Hu J, Ouyang L, Li J, Li X, Zhong Y, Hou C. Mean Blood Glucose Level During ICU Hospitalization is a Strong Predictor of the Mortality of COVID-19. Diabetes Metab Syndr Obes 2024; 17:1903-1909. [PMID: 38706805 PMCID: PMC11070158 DOI: 10.2147/dmso.s450489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Objective To investigate the potential prognostic value of mean blood glucose (MBG) in hospital for prognosis of COVID-19 adult patients in the intensive unit care unit (ICU). Methods A single-site and retrospective study enrolled 107 patients diagnosed as COVID-19 from department of critical care medicine in the Second Xiangya Hospital between October 2022 and June 2023. Demographic information including glucose during ICU hospitalization, comorbidity, clinical data, types of medications and treatment, and clinical outcome were collected. The multivariate logistic and cox regression was used to explore the relationship between blood glucose changes and clinical outcomes of COVID-19 during ICU stay. Results In total, 107 adult patients confirmed with COVID-19 were included. Multivariate logistic regression results showed an increase in MBG was associated with ICU mortality rate. Compared with normal glucose group (MBG <= 7.8 mmol/L), the risk of ICU mortality, 7-day mortality and 28-day mortality from COVID-19 were significantly increased in high glucose group (MBG >7.8mmol/L). Conclusion MBG level during ICU hospitalization was strongly correlated to all-cause mortality and co-infection in COVID-19 patients. These findings further emphasize the importance of overall glucose management in severe cases of COVID-19.
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Affiliation(s)
- Jie Hu
- Critical Care Medicine Center, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Key Laboratory Diseases Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Lin Ouyang
- Department of Critical Care Medicine Center, Guilin Hospital of the Second Xiangya Hospital, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Jinxiu Li
- Critical Care Medicine Center, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Key Laboratory Diseases Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Yanjun Zhong
- Critical Care Medicine Center, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Can Hou
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Key Laboratory Diseases Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Ali El Chab Parolin S, Benicio Stocco R, Kneipp Lopes JDC, Curcio Pereira MR, Massae Yamashita M, Domareski Goulart ME, Demeneck H, Olandoski M, Hermann de Souza Nunes L, Keniche Morisawa V, Fanhani Cracco LA, Busto Silva I, Silva Motta Júnior J, Veit Barreto D, Lenci Marques G, Proença de Moraes T, Pellegrino Baena C. Association between inpatient glycemic variability and COVID-19 mortality: a prospective study. Diabetol Metab Syndr 2023; 15:185. [PMID: 37697407 PMCID: PMC10494398 DOI: 10.1186/s13098-023-01157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND This study aimed to determine the association between glycemic variability (GV) and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS We prospectively analyzed data from inpatients (> 18 years old) with RT-PCR confirmed COVID-19 admitted between March 2020 and July 2021. All patients were hospitalized for more than 48 h and had at least six point-of-care capillary glucose tests obtained three times daily in the pre-prandial period during hospitalization. GV was measured using the glucose standard deviation (SD) and coefficient of variation (CV). ROC curve was adjusted to determine the SD and CV cutoff values associated with mortality (44.7 mg/dL and 27.5%, respectively); values above these were considered indicative of high GV. Logistic regression models were fitted to explore the association between GV and mortality in patients with and without diabetes. RESULTS A total of 628 patients were stratified into SD < 44.7 mg/dL (n = 357) versus ≥ 44.7 mg/dL (n = 271) and CV < 27.5% (n = 318) versus ≥ 27.5% (n = 310) groups. After controlling for age, sex, presence of diabetes mellitus (DM) and cardiovascular disease, we found a significant association between high GV and mortality (odds ratio 2.99 [1.88-4.77] for SD and 2.43 [1.54-3.85] for CV; p values < 0.001). The mortality rate was higher with SD ≥ 44.7 mg/dL and CV ≥ 27.5% compared to that with SD < 44.7 mg/dL and CV < 27.5%, regardless of DM (p < 0.001 for all). CONCLUSION High glycemic variability was independently associated with mortality in patients with and without DM, who were hospitalized with COVID-19.
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Affiliation(s)
- Salma Ali El Chab Parolin
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - Rebecca Benicio Stocco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Julia do Carmo Kneipp Lopes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcos Roberto Curcio Pereira
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Milena Massae Yamashita
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Henrique Demeneck
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcia Olandoski
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Victor Keniche Morisawa
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Luiz Augusto Fanhani Cracco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Isabela Busto Silva
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Jarbas Silva Motta Júnior
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Daniela Veit Barreto
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Gustavo Lenci Marques
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Thyago Proença de Moraes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Cristina Pellegrino Baena
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
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Chander S, Deepak V, Kumari R, Leys L, Wang HY, Mehta P, Sadarat FNU. Glycemic Control in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072555. [PMID: 37048638 PMCID: PMC10094858 DOI: 10.3390/jcm12072555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Given the mortality risk in COVID-19 patients, it is necessary to estimate the impact of glycemic control on mortality rates among inpatients by designing and implementing evidence-based blood glucose (BG) control methods. There is evidence to suggest that COVID-19 patients with hyperglycemia are at risk of mortality, and glycemic control may improve outcomes. However, the optimal target range of blood glucose levels in critically ill COVID-19 patients remains unclear, and further research is needed to establish the most effective glycemic control strategies in this population. Methods: The investigation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data sources were drawn from Google Scholar, ResearchGate, PubMed (MEDLINE), Cochrane Library, and Embase databases. Randomized controlled trials, non-randomized controlled trials, retrospective cohort studies, and observational studies with comparison groups specific to tight glycemic control in COVID-19 patients with and without diabetes. Results: Eleven observational studies (26,953 patients hospitalized for COVID-19) were included. The incidence of death was significantly higher among COVID-19 patients diagnosed with diabetes than those without diabetes (OR = 2.70 [2.11, 3.45] at a 95% confidence interval). Incidences of death (OR of 3.76 (3.00, 4.72) at a 95% confidence interval) and complications (OR of 0.88 [0.76, 1.02] at a 95% confidence interval) were also significantly higher for COVID-19 patients with poor glycemic control. Conclusion: These findings suggest that poor glycemic control in critically ill patients leads to an increased mortality rate, infection rate, mechanical ventilation, and prolonged hospitalization.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Correspondence:
| | - Vishal Deepak
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Roopa Kumari
- Department of Pathology, Mount Sinai Morningside, and Mount Sinai West, New York, NY 10025, USA
| | - Lorenzo Leys
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Mount Sinai Morningside, and Mount Sinai West, New York, NY 10025, USA
| | - Hong Yu Wang
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
| | - Puja Mehta
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT 06510, USA
| | - FNU Sadarat
- Department of Internal Medicine, University of Buffalo, New York, NY 14215, USA
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Wakabayashi Y, Nakayama S, Yamamoto A, Kitazawa T. High D-glucose levels induce ACE2 expression via GLUT1 in human airway epithelial cell line Calu-3. BMC Mol Cell Biol 2022; 23:29. [PMID: 35836103 PMCID: PMC9282902 DOI: 10.1186/s12860-022-00427-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the host cell by binding to angiotensin-converting enzyme 2 (ACE2) receptors. ACE2 is expressed on human airway epithelial cells. Increased ACE2 expression may be associated with potentially high risk of COVID-19. However, the factors responsible for the regulation of ACE2 expression in human airway epithelial cells are unknown. Furthermore, hyperglycemia is a risk factor for poor disease prognosis. Results In this study, we investigated the effects of D-glucose on ACE2 mRNA and protein expressions in Calu-3 bronchial submucosal cells. The cells were cultured in minimal essential medium containing different D-glucose concentrations. After 48 and 72 h of high D-glucose (1000 mg/dL) treatment, ACE2 mRNA expressions were significantly increased. ACE2 protein expressions were significantly increased after 24 h of high D-glucose treatment. ACE2 mRNA expression was enhanced by a D-glucose concentration of 550 mg/dL or more after 72 h of treatment. In addition, we investigated the role of glucose transporters (GLUTs) in Calu-3 cells. ACE2 mRNA and protein expressions were suppressed by the GLUT1 inhibitor BAY-876 in high D-glucose-treated Calu-3 cells. GLUT-1 siRNA was also used and ACE2 mRNA expressions were suppressed in high D-glucose-treated Calu-3 cells with GLUT-1 knockdown. Conclusions This is the first report indicating that high D-glucose levels induced ACE2 expression via GLUT1 in bronchial submucosal cells in vitro. As hyperglycemia can be treated appropriately, these findings could help reduce the risk of worsening of coronavirus disease 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12860-022-00427-4. SARS-CoV-2 enters the host cell by binding to its receptor, angiotensin-converting enzyme 2 (ACE2). ACE2 is expressed in many cell types, including bronchial epithelial cells. High D-glucose medium induced ACE2 expression in bronchial epithelial Calu-3 cells. Glucose transporter 1 (GLUT1) is expressed in Calu-3 cells, and GLUT1 inhibition decreased ACE2 expression.
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Abstract
The traditional complications of diabetes mellitus are well known and continue to pose a considerable burden on millions of people living with diabetes mellitus. However, advances in the management of diabetes mellitus and, consequently, longer life expectancies, have resulted in the emergence of evidence of the existence of a different set of lesser-acknowledged diabetes mellitus complications. With declining mortality from vascular disease, which once accounted for more than 50% of deaths amongst people with diabetes mellitus, cancer and dementia now comprise the leading causes of death in people with diabetes mellitus in some countries or regions. Additionally, studies have demonstrated notable links between diabetes mellitus and a broad range of comorbidities, including cognitive decline, functional disability, affective disorders, obstructive sleep apnoea and liver disease, and have refined our understanding of the association between diabetes mellitus and infection. However, no published review currently synthesizes this evidence to provide an in-depth discussion of the burden and risks of these emerging complications. This Review summarizes information from systematic reviews and major cohort studies regarding emerging complications of type 1 and type 2 diabetes mellitus to identify and quantify associations, highlight gaps and discrepancies in the evidence, and consider implications for the future management of diabetes mellitus.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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