Outcomes in Hyperglycemic Patients Affected by COVID-19: Can We Do More on Glycemic Control?
figureposted on 14.05.2020 by Celestino Sardu, Nunzia D’Onofrio, Maria Luisa Balestrieri, Michelangela Barbieri, Maria Rosaria Rizzo, Vincenzo Messina, Paolo Maggi, Nicola Coppola, Giuseppe Paolisso, Raffaele Marfella
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OBJECTIVE: An important prognostic factor in any form of infection seems to be glucose control in type 2 diabetic patients (T2DM). There are no informations about the effects of tight glycemic control on Covid-19 outcomes of hyperglycemic patients. Therefore, we examined the effects of optimal glycemic control in hyperglycemic Covid-19 patients.
RESEARCH DESIGN AND METHODS: Fifty-nine Covid-19 patients hospitalized with moderate disease were evaluated. Based on admission glycemia >7.77 mmol/L, patients were divided in hyperglycemic and normoglycemic. Interleukin-6 (IL-6) and D-dimer levels were evaluated at admission and weekly during hospitalization. The composite end-point was severe disease: admission to an intensive care unit, use of mechanical ventilation, or death.
RESULTS: Thirty-four (57.6%) were normoglycemics and 25 (42.4%) were hyperglycemics. In hyperglycemics 7 (28%) and 18 patients (72%) were diagnosed with diabetes already before admission. In hyperglycemics, 10 (40%) were treated without insulin-infusion and 15 (60%) were treated with insulin-infusion. The mean of glycemia during hospitalization were 10.65±0.84 mmol/L in no-insulin infusion-group and 7.69±1.85 mmol/L in insulin infusion-group. At baseline, IL-6 and D-dimer levels were significantly higher in hyperglycemic than normoglycemic patients (P<0.001). Despite all patients were on standard treatment for Covid-19 infection, IL-6 and D-dimer levels persisted higher in hyperglycemics during hospitalization. In a risk adjusted Cox-regression analysis, both hyperglycemic and diabetic had higher risk of severe disease than non-diabetic and normoglycemic patients. Cox-regression analysis evidenced that hyperglycemic patients treated with insulin-infusion had lower risk of severe disease than patients without insulin-infusion.
CONCLUSIONS: Insulin-infusion may be effective method for achieving glycemic targets and improving outcomes in Covid-19 patients.