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Gholamalizadeh M, Salimi Z, Mobarakeh KA, Mahmoudi Z, Tajadod S, Mousavi Mele M, Alami F, Bahar B, Doaei S, Khoshdooz S, Rahvar M, Gholami S, Pourtaleb M. The association between enteral nutrition with survival of critical patients with COVID-19. Immun Inflamm Dis 2024; 12:e1261. [PMID: 38717056 PMCID: PMC11078021 DOI: 10.1002/iid3.1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) results in several complications and mortality in intensive care unit (ICU) patients. Limited studies have investigated the effect of enteral nutrition (EN) on the survival of COVID-19 patients in the ICU. The aim of this study was to investigate the association of EN with biochemical and pathological indices associated with mortality in ICU patients with COVID-19. METHODS This case-control study was conducted on 240 patients with COVID-19 hospitalized in the ICU including 120 eventual nonsurvived as the cases and 120 survived patients as the controls. All of the patients received EN as a high protein high volume or standard formula. Data on general information, anthropometric measurements, and the results of lab tests were collected. RESULTS The recovered patients received significantly more high protein (60.8% vs. 39.6%, p = .004) and high volume (61.6% vs. 42.3%, p = .005) formula compared to the nonsurvived group. Mortality was inversely associated with high volume (odds ratio [OR]: 0.45 confidence interval [CI]95%, p = .008) and high protein (OR: 0.42 CI95%, p = .003) formula. The results remained significant after adjusting for age and sex. Further adjustment for underlying diseases, smoking, body mass index, and the acute physiology and chronic health evaluation II (APACHE II) score did not change the results. CONCLUSION The findings of the study showed that there was a significant inverse association between mortality and high volume and high protein formula in patients with COVID-19. Further investigation is warranted.
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Affiliation(s)
| | - Zahra Salimi
- Student Research Committee, Faculty of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Khadijeh Abbasi Mobarakeh
- Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Zahra Mahmoudi
- Department of NutritionScience and Research Branch Islamic Azad UniversityTehranIran
| | - Shirin Tajadod
- Department of Nutrition, School of Public Health, International CampusIran University of Medical SciencesTehranIran
| | | | - Farkhondeh Alami
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport and Health SciencesUniversity of Central LancashirePrestonUK
| | - Bojlul Bahar
- Department of Nutrition, Student Research Committee, Faculty of MedicineUrmia University of Medical SciencesUrmiaIran
| | - Saeid Doaei
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Sara Khoshdooz
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Masoume Rahvar
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Somayeh Gholami
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Masoume Pourtaleb
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
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Manoharan EV, Kola Sridharan N, Kesavan B, Andrews GA, Sundaram Venkatesan G, Kesavan P. COVID-19 Pneumonia and Increased Insulin Requirement in Known Diabetic Patients: A Prospective Observational Study. Cureus 2023; 15:e50239. [PMID: 38192935 PMCID: PMC10773652 DOI: 10.7759/cureus.50239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Background COVID-19-related critical illness affects multiple organs and causes a variety of metabolic derangements in the body's physiology that are not proven with the current level of evidence. Insulin resistance and deranged blood sugar control due to COVID-19 have been major problems when managing diabetic patients with hyperglycaemia when they are admitted with COVID-19 pneumonia. There is a lack of abundant literature to prove the excess insulin requirements of COVID-19 and to quantify their insulin needs scientifically. This study aims to quantify the degree of insulin dose increments in these patients. Materials and methods The study is a single-centre prospective observational study done in COVID-19 wards at a tertiary care hospital in India. The diabetic patients admitted with COVID-19 pneumonia between June 2020 and December 2020 were included in the study. Seventy-five patients with fair control of diabetes (HbA1C <7.5) were included in the study. Their average daily insulin requirement was calculated for the first seven days of admission. This was tabulated and compared to their baseline insulin requirement before being unwell due to COVID-19. A sub-group analysis was also done to show the relation between severity of illness and glycaemic dysregulation. Result Invariably, all patients were found to be hyperglycaemic on admission. Insulin need has increased to 1.5 to 2.5 times the baseline values in the first 24 hours of admission. This insulin dose requirement stayed high around the same levels for all seven days of observation. The average mean value of the daily insulin dose for the seven days of study was calculated to be 132 units. This is more than twice the mean baseline daily insulin requirement of 62 units during the pre-COVID-19 period. Subgroup analysis showed that the severe group had poor glycaemic control, requiring higher doses compared to their own baseline and also to the moderate group. Conclusion COVID-19 pneumonia significantly increases insulin resistance and insulin requirements during illness in fairly controlled known diabetic patients with insulin. Managing this COVID-19-induced hyperglycaemia requires 1.5 to 2.5 times the baseline insulin doses.
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Affiliation(s)
| | | | - Balaji Kesavan
- Anaesthesiology, University Hospital of North Tees, Stockton-on-Tees, GBR
| | - Geront A Andrews
- Anaesthesiology and Critical Care, Rela Institute and Medical Centre, Chennai, IND
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Xu AY, Wang SH, Duong TQ. Patients with prediabetes are at greater risk of developing diabetes 5 months postacute SARS-CoV-2 infection: a retrospective cohort study. BMJ Open Diabetes Res Care 2023; 11:e003257. [PMID: 37295808 PMCID: PMC10276968 DOI: 10.1136/bmjdrc-2022-003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/21/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Patients with prediabetes who contract SARS-CoV-2 infection (COVID-19) could be at higher risk of developing frank diabetes compared those who do not. This study aims to investigate the incidence of new-onset diabetes in patients with prediabetes after COVID-19 and if it differs from those not infected. RESEARCH DESIGN AND METHODS Using electronic medical record data, 42 877 patients with COVID-19, 3102 were identified as having a history of prediabetes in the Montefiore Health System, Bronx, New York. During the same time period, 34 786 individuals without COVID-19 with history of prediabetes were identified and 9306 were propensity matched as controls. SARS-CoV-2 infection status was determined by a real-time PCR test between March 11, 2020 and August 17, 2022. The primary outcomes were new-onset in-hospital diabetes mellitus (I-DM) and new-onset persistent diabetes mellitus (P-DM) at 5 months after SARS-CoV-2 infection. RESULTS Compared with hospitalized patients without COVID-19 with history of prediabetes, hospitalized patients with COVID-19 with history of prediabetes had a higher incidence of I-DM (21.9% vs 6.02%, p<0.001) and of P-DM 5 months postinfection (14.75% vs 7.51%, p<0.001). Non-hospitalized patients with and without COVID-19 with history of prediabetes had similar incidence of P-DM (4.15% and 4.1%, p>0.05). Critical illness (HR 4.6 (95% CI 3.5 to 6.1), p<0.005), in-hospital steroid treatment (HR 2.88 (95% CI 2.2 to 3.8), p<0.005), SARS-CoV-2 infection status (HR 1.8 (95% CI 1.4 to 2.3), p<0.005), and hemoglobin A1c (HbA1c) (HR 1.7 (95% CI 1.6 to 1.8), p<0.005) were significant predictors of I-DM. I-DM (HR 23.2 (95% CI 16.1 to 33.4), p<0.005), critical illness (HR 2.4 (95% CI 1.6 to 3.8), p<0.005), and HbA1c (HR 1.3 (95% CI 1.1 to 1.4), p<0.005) were significant predictors of P-DM at follow-up. CONCLUSIONS SARS-CoV-2 infection confers a higher risk for developing persistent diabetes 5 months post-COVID-19 in patients with prediabetes who were hospitalized for COVID-19 compared with COVID-19-negative counterparts with prediabetes. In-hospital diabetes, critical illness, and elevated HbA1c are risk factors for developing persistent diabetes. Patients with prediabetes with severe COVID-19 disease may need more diligent monitoring for developing P-DM postacute SARS-CoV-2 infection.
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Affiliation(s)
- Alexander Y Xu
- Radiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen H Wang
- Radiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Tim Q Duong
- Radiology, Albert Einstein College of Medicine, Bronx, New York, USA
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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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Dumitrascu AG, Perry MF, Boone RJ, Guzman MP, Chirila RM, McNally AW, Colibaseanu DT, Meek SE, Ball CT, White LJ, Chindris AM. Continuous Glucose Monitoring for Patients with COVID-19 Pneumonia: Initial Experience at a Tertiary Care Center. Endocr Pract 2023; 29:155-161. [PMID: 36566985 PMCID: PMC9773786 DOI: 10.1016/j.eprac.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patients hospitalized with COVID-19 and hyperglycemia require frequent glucose monitoring, usually performed with glucometers. Continuous glucose monitors (CGMs) are common in the outpatient setting but not yet approved for hospital use. We evaluated CGM accuracy, safety for insulin dosing, and CGM clinical reliability in 20 adult patients hospitalized with COVID-19 and hyperglycemia. METHODS Study patients were fitted with a remotely monitored CGM. CGM values were evaluated against glucometer readings. The CGM sensor calibration was performed if necessary. CGM values were used to dose insulin, without glucometer confirmation. RESULTS CGM accuracy against glucometer, expressed as mean absolute relative difference (MARD), was calculated using 812 paired glucometer-CGM values. The aggregate MARD was 10.4%. For time in range and grades 1 and 2 hyperglycemia, MARD was 11.4%, 9.4%, and 9.1%, respectively, with a small variation between medical floors and intensive care units. There was no MARD correlation with mean arterial blood pressure levels, oxygen saturation, daily hemoglobin levels, and glomerular filtration rates. CGM clinical reliability was high, with 99.7% of the CGM values falling within the "safe" zones of Clarke error grid. After CGM placement, the frequency of glucometer measurements decreased from 5 to 3 and then 2 per day, reducing nurse presence in patient rooms and limiting viral exposure. CONCLUSION With twice daily, on-demand calibration, the inpatient CGM use was safe for insulin dosing, decreasing the frequency of glucometer fingersticks. For glucose levels >70 mg/dL, CGMs showed adequate accuracy, without interference from vital and laboratory values.
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Affiliation(s)
- Adrian G Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida.
| | - Michelle F Perry
- Division of Endocrinology, Mayo Clinic Florida, Jacksonville, Florida
| | - Rebecca J Boone
- Division of Endocrinology, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Razvan M Chirila
- Division of International and Executive Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | - Allyson W McNally
- Division of Endocrinology, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Shon E Meek
- Division of Endocrinology, Mayo Clinic Florida, Jacksonville, Florida
| | - Colleen T Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, Florida
| | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, Florida
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Burgos R, García-Almeida JM, Matía-Martín P, Palma S, Sanz-Paris A, Zugasti A, Alfaro JJ, Fullana AA, Continente AC, Chicetru MJ, Malpartida KG, Faes ÁG, Sánchez VG, López ML, Ortega AJM, Roldán JO, Moreno CS, Llanos PS. Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection. Rev Endocr Metab Disord 2022; 23:205-213. [PMID: 35244834 PMCID: PMC8895363 DOI: 10.1007/s11154-022-09714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus and/or hyperglycemia are highly prevalent medical conditions in patients hospitalized for coronavirus disease 2019 (COVID-19) and are associated with adverse outcomes. In addition, COVID-19 itself can provoke fluctuating and high glucose levels that can be difficult to manage upon hospitalization. Hospitalized patients with COVID-19 are at high risk of malnutrition due to an increase in nutritional requirements and a severe acute inflammatory response. The management of patients with diabetes/hyperglycemia and COVID-19 is challenging and requires a specific nutritional approach, the purpose of which is to fulfill the nutritional requirements while maintaining an optimal glycemic control. In this study, an expert group of nutritional endocrinologists carried out a qualitative literature review and provided recommendations based on evidence and guidelines, when available, or on their own experience. The optimal care based on these recommendations was compared with the routine bedside care as reported by a panel of physicians (mainly, endocrinologists, geriatricians, and internists) treating patients with diabetes/hyperglycemia and COVID-19 in their daily practice. Early screening and diagnosis, a diabetes-specific therapeutic approach, and a close malnutrition monitoring are essential to improve the clinical outcomes of these patients. In conclusion, the proposed recommendations are intended to provide a useful guide on the clinical management of malnutrition in patients with COVID-19 and diabetes/hyperglycemia, in order to improve their outcomes and accelerate their recovery. The comparison of the recommended optimal care with routine clinical practice could aid to identify gaps in knowledge, implementation difficulties, and areas for improvement in the management of malnutrition in this population.
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Affiliation(s)
- Rosa Burgos
- Unidad de Soporte Nutricional, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Pilar Matía-Martín
- Departamento de Endocrinología Y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Samara Palma
- Unidad de Nutrición Clínica Y Dietética, Hospital Universitario de La Paz, Madrid, Spain
| | - Alejandro Sanz-Paris
- Nutrition Department, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009, Zaragoza, Spain.
| | - Ana Zugasti
- Unidad de Nutrición Clínica, Hospital Universitario de Navarra, 31008, Pamplona, Spain
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7
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Longo M, Scappaticcio L, Petrizzo M, Castaldo F, Sarnataro A, Forestiere D, Caiazzo F, Bellastella G, Maiorino MI, Capuano A, Esposito K. Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring. J Endocrinol Invest 2022; 45:445-452. [PMID: 34482534 PMCID: PMC8418789 DOI: 10.1007/s40618-021-01669-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE This study is aimed at evaluating changes in metrics of glucose control in home-isolated patients with type 1 diabetes and COVID-19 using a continuous glucose monitoring (CGM) system. METHODS We included adults aged 18-45 years with type 1 diabetes, using CGM, followed by telemedicine at a Southern Italian University Hospital. Thirty-two home-quarantined subjects with SARS-CoV-2 positive swab constituted the COVID-19 group. Thirty age-matched diabetic individuals without COVID-19 formed the control group. The effects of COVID-19 on glycemic control in patients infected were assessed at different time points [2 weeks before-COVID-19 (Time 1), 2 weeks during-COVID-19 (Time 2) and 2 weeks after COVID-19 (Time 3)] and compared with those without infection. RESULTS A significant reduction of TIR (Time 1 vs Time 2, %, 60.1 ± 16.6 vs 55.4 ± 19.2, P = 0.03), associated with a significant increase of TAR level 2 (10.1 ± 7.3 vs 16.7 ± 12.9, P < 0.001), GMI (7.1 ± 0.6 vs 7.5 ± 0.8, P < 0.001), CV (37.3 ± 7.1 vs 39.6 ± 7.0, P = 0.04), mean glucose values (mg/dL, 160.2 ± 26.5 vs 175.5 ± 32.6, P = 0.001) and standard deviation (59.2 ± 13.1 vs 68.6 ± 17.7, P = 0.001) was observed in patients with COVID-19. No significant change of glycemic metrics was found in the NO COVID-19 group across the time. CONCLUSION Young home-isolated patients with type 1 diabetes and COVID-19 showed a worsening of glucose control during COVID-19, as compared with age-matched diabetic subjects without the infection.
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Affiliation(s)
- M Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - L Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - M Petrizzo
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Castaldo
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - A Sarnataro
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - D Forestiere
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - F Caiazzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - G Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
| | - M I Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy.
- Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy.
| | - A Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - K Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138, Naples, Italy
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
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Czupryniak L, Dicker D, Lehmann R, Prázný M, Schernthaner G. The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence? Cardiovasc Diabetol 2021; 20:198. [PMID: 34598700 PMCID: PMC8485772 DOI: 10.1186/s12933-021-01389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available—but currently limited—evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Centre, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roger Lehmann
- Department of Endocrinology, Diabetes and Nutrition, University Hospital Zürich, Zürich, Switzerland
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, 1030, Vienna, Austria. .,Medical University of Vienna, Vienna, Austria.
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Morse J, Gay W, Korwek KM, McLean LE, Poland RE, Guy J, Sands K, Perlin JB. Hyperglycaemia increases mortality risk in non-diabetic patients with COVID-19 even more than in diabetic patients. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00291. [PMID: 34505406 PMCID: PMC8420416 DOI: 10.1002/edm2.291] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023]
Abstract
Aim Diabetes has been identified as a risk factor for poor outcomes in patients with COVID‐19. We examined the association of hyperglycaemia, both in the presence and absence of pre‐existing diabetes, with severity and outcomes in COVID‐19 patients. Methods Data from 74,148 COVID‐19‐positive inpatients with at least one recorded glucose measurement during their inpatient episode were analysed for presence of pre‐existing diabetes diagnosis and any glucose values in the hyperglycaemic range (>180 mg/dl). Results Among patients with and without a pre‐existing diabetes diagnosis on admission, mortality was substantially higher in the presence of high glucose measurements versus all measurements in the normal range (70–180 mg/dl) in both groups (non‐diabetics: 21.7% vs. 3.3%; diabetics 14.4% vs. 4.3%). When adjusting for patient age, BMI, severity on admission and oxygen saturation on admission, this increased risk of mortality persisted and varied by diabetes diagnosis. Among patients with a pre‐existing diabetes diagnosis, any hyperglycaemic value during the episode was associated with a substantial increase in the odds of mortality (OR: 1.77, 95% CI: 1.52–2.07); among patients without a pre‐existing diabetes diagnosis, this risk nearly doubled (OR: 3.07, 95% CI: 2.79–3.37). Conclusion This retrospective analysis identified hyperglycaemia in COVID‐19 patients as an independent risk factor for mortality after adjusting for the presence of diabetes and other known risk factors. This indicates that the extent of glucose control could serve as a mechanism for modifying the risk of COVID‐19 morality in the inpatient environment.
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Affiliation(s)
- Jennifer Morse
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Wendy Gay
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Laura E McLean
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | | | - Jeffrey Guy
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
| | - Kenneth Sands
- Clinical Operations Group, HCA Healthcare, Nashville, TN, USA
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Ortega E, Corcoy R, Gratacòs M, Cos Claramunt FX, Mata-Cases M, Puig-Treserra R, Real J, Vlacho B, Castelblanco E, Domingo P, Khunti K, Franch-Nadal J, Mauricio D. Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study. BMJ Open 2021; 11:e051237. [PMID: 34301668 PMCID: PMC8300551 DOI: 10.1136/bmjopen-2021-051237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIM This study's objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM). DESIGN This was a cross-sectional study. SETTINGS We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain. OUTCOME MEASURES Multiple 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. RESULTS Overall, 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. CONCLUSION The 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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Affiliation(s)
- Emilio Ortega
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Francesc Xavier Cos Claramunt
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Innovation office, Institut Català de la Salut, Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ramon Puig-Treserra
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Esmeralda Castelblanco
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pere Domingo
- Infectious Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Institut de Recerca Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Didac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
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Lockhart SM, Griffiths H, Petrisor B, Usman A, Calvo-Latorre J, Heales L, Bansiya V, Mahroof R, Conway Morris A. 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. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00228. [PMID: 34268452 PMCID: PMC7995054 DOI: 10.1002/edm2.228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 01/18/2023]
Abstract
Introduction Severe COVID‐19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS‐CoV‐2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID‐19 and non‐COVID‐19 viral pneumonitis. Methods This is a retrospective cohort study of patients with severe COVID‐19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non‐COVID‐19 viral pneumonitis patients was identified from routinely collected audit data. Results Insulin requirements were similar in patients with COVID‐19 and non‐COVID‐19 viral pneumonitis after adjustment for pre‐existing diabetes and severity of respiratory failure. Conclusions In this single‐centre study, we could not find evidence of a unique diabetogenic effect of COVID‐19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre‐existing metabolic disease.
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Affiliation(s)
- Sam M Lockhart
- MRC Metabolic Diseases Unit Wellcome Trust-Medical Research Council Institute of Metabolic Science University of Cambridge Cambridge UK.,Wolfson Diabetes and Endocrinology Clinic Cambridge University Hospital NHS Foundation Trust Cambridge UK.,John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Harry Griffiths
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Bogdan Petrisor
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Ammara Usman
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Julia Calvo-Latorre
- Wolfson Diabetes and Endocrinology Clinic Cambridge University Hospital NHS Foundation Trust Cambridge UK
| | - Laura Heales
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Vishakha Bansiya
- Wolfson Diabetes and Endocrinology Clinic Cambridge University Hospital NHS Foundation Trust Cambridge UK
| | - Razeen Mahroof
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK
| | - Andrew Conway Morris
- John Farman Intensive Care Unit Addenbrooke's Hospital Cambridge UK.,University Division of Anaesthesia Department of Medicine University of Cambridge Cambridge UK
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