Comparative Analysis Methods in Optimizing Corticosteroid Therapy in Patients with Covid-19 and Diabetes Mellitus

Abstract

Background: The method of comparative analysis is one of the most common in science where optimal choices are required. Despite the fact the method is empirical, under the conditions of epidemics such as Covid-19, it is one of the most affordable in assessing the effectiveness of the therapy. Patients with diabetes having coronavirus infection are included in the risk group which required steroid therapy. In patients with diabetes, excessive usage of Exogenous corticosteroids creates insulin deficiency which leads to hyperglycemia and the risk of developing coma. Purpose of the study: сompare the effectiveness and safety of using corticosteroids in patients with Covid-19 and diabetes prescribed "by standards" and "method of calculation". Method: Diabetic Patients with novel coronavirus infection were screened (n = 107).All patients were divided into 3 groups.In group 1(n=35) patients received dexamethasone at a dosage of 0.1 mg/kg once a day in the morning intravenously; in group 2(n = 38), patients received dexamethasone 20 mg twice daily intravenously in the morning and evening (more than 0.2 mg/kg/day) and in group 3(n = 34) patients received dexamethasone 0.1 mg /kg once a day in the morning intramuscularly. Comparative analysis were carried out according to the criteria: the period of intoxication, glycemic variability, CRP, leukocyte counts, D-dimer, and transaminases. For analysis STATISTIC 10,0 computer program was used (Matematica®, Matlab®, HarvardGraphics®) StatSoft). Results: In all the groups after therapy it was noted redistributive leukocytosis.In patients receiving high therapeutic dose (group 2) initially suppressed production of leukocytes is activated and reaches the normative indicator (p<0.001) and the indicators are comparable to the data of group 3(p<0.001)in which patients received glucocorticoids at a lower dose (0.1 mg/kg/day) intramuscularly. The most significant decrease in D-dimer levels was in patients with a dosage of dexamethasone at the rate of 0.1 units/kg once a day intravenously by 80.9%(P <0.0001);intramuscularly by 73.2%(P<0.00001)and with intravenously at a dose of more than 0.2 units/kg there was a decrease in the level of D-dimer by 67.9% (P <0.00001). Decrease in CRP (cytokine storm relief rate) did not differ significantly between the groups, which eliminates the role of inexpedient usage of dexamethasone in dosages of more than 0.2 units/kg/day.Fasting blood glucose in patients in group 3 increased by 22% (P<0.0002); in group 1 only by 12% (P <0.05)and in group 2 by 32% (P <0.0001). In all the groups, an increase was observed in postprandial glucose, and in group 2 to the level of developing ketoacidosis and required emergency intervention by increasing the dose of insulin. Conclusion: For patients without diabetes, the dose of dexamethasone is prescribed in accordance with standards (average dose) regardless of body weight and concomitant diseases. In patients with diabetes are required to determine the dose of dexamethasone individually at the rate of 0.1 mg /kg body weight per day. This method reduces the risk of adverse outcomes and ensures the achievement of positive dynamics of clinical and laboratory parameters which ultimately reduces mortality and shortens the recovery time.