Outcomes in Hyperglycemic Patients Affected by COVID-19: Can We Do More on Glycemic Control?
figureposted on 14.05.2020, 13:32 by Celestino Sardu, Nunzia D’Onofrio, Maria Luisa Balestrieri, Michelangela Barbieri, Maria Rosaria Rizzo, Vincenzo Messina, Paolo Maggi, Nicola Coppola, Giuseppe Paolisso, Raffaele Marfella
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.