Dexamethasone therapy in COVID‐19 patients: implications and guidance for the management of blood glucose in people with and without diabetes

Rayman, Gerry; Lumb, Alistair; Kennon, Brian; Cottrell, Christine; Nagi, Dinesh; Page, E.; Voigt, D.; Courtney, Hamish; Atkins, H.; Higgins, Kath; Platts, Julia; Dhatariya, Ketan; Patel, Mayank; Newland‐Jones, Philip; Narendran, Parth; Kar, Partha; Burr, O.; Thomas, Stephen; Stewart, Rose

doi:10.1111/dme.14378

Cited by 66 publications

(80 citation statements)

References 5 publications

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“…The UK National In-patient diabetes COVID-19 response group provides specific guidance on the management of diabetes during dexamethasone treatment, highlighting the need for regular glucose monitoring and insulin treatment if required. 35 Diabetes teams have a key role in preventing admissions to hospital and part of this involves close liaison with community services at the time of discharge. During the admission, diabetes treatments may have changed and new support, particularly for vulnerable people with specific care needs, may be required after discharge to prevent hypoglycaemia, recurrence of hyperglycaemia and DKA.…”

Section: Guidance From the Uk National Inpatient Diabetes Covid-19 mentioning

confidence: 99%

“…Alternative subcutaneous insulin regimens may be required for those with hyperglycaemia or mild DKA if syringe drivers are unavailable to administer intravenous insulin safely. The UK National In‐patient diabetes COVID‐19 response group provides specific guidance on the management of diabetes during dexamethasone treatment, highlighting the need for regular glucose monitoring and insulin treatment if required 35 …”

Section: Diabetes and Covid‐19mentioning

confidence: 99%

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Impact of diabetes on COVID‐19 and other infection: Report from the 22nd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium

Luk

Holt

2021

Diabet Med

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The coronavirus disease 2019 (COVID-19) pandemic has posed enormous challenges to healthcare systems worldwide. The negative impact of COVID-19 is widespread and includes not only people who contracted the disease but also those with chronic morbidities such as diabetes whose care is compromised due to diversion of medical resources. People with diabetes are generally more susceptible to infection as a result of altered immunity. People with diabetes have a worse prognosis from COVID-19 and there is evidence to suggest that severe acute respiratory syndrome coronavirus 2 may directly affect pancreatic function precipitating hyperglycaemic crises. In the United Kingdom, one of the most heavily affected countries, guidelines are in place to unify the management of people with diabetes hospitalized for COVID-19. Diabetes services are re-organized to ensure that medical care of people with diabetes is maintained despite resource and other practical constraints. Public health measures including social distancing, hand hygiene and the use of face masks are crucial in containing community transmission of the virus. Hong Kong, one of the most densely populated city in the world, is particularly vulnerable and has in place a stringent containment policy and aggressive contact tracing to ensure public safety during this pandemic.

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Section: Guidance From the Uk National Inpatient Diabetes Covid-19 mentioning

confidence: 99%

Section: Diabetes and Covid‐19mentioning

confidence: 99%

Impact of diabetes on COVID‐19 and other infection: Report from the 22nd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium

Luk

Holt

2021

Diabet Med

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“…Evidence is continuing to emerge that the people from black, Asian, and minority ethnic (BAME) communities are susceptible to COVID-19 pandemic [9][10][11]. To date, only Remdesivir [12][13][14][15] and Dexamethasone [16,17] have demonstrated a positive response in a prospective for the treatment of patients with COVID-19, while Chloroquine or Hydroxychloroquine were suggested to be used with caution because they have a lot of side effects and their efficacy are controversial [18][19][20]. So far, there is no effective vaccine for COVID-19 used in population on large scale.…”

Section: Introductionmentioning

confidence: 99%

A cohort study of 676 patients indicates D-dimer is a critical risk factor for the mortality of COVID-19

Huang

Lyu

et al. 2020

PLoS ONE

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Coronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. However, the information on the risk factors associated with the mortality of COVID-19 and of their prognostic potential is limited. In this retrospective study, the clinical characteristics, treatment and outcome data were collected and analyzed from 676 COVID-19 patients stratified into 140 non-survivors and 536 survivors. We found that the levels of Dimerized plasmin fragment D (D-dimer), C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in non-survivals on admission (non-survivors vs. survivors: D-Dimer ≥ 0.5 mg/L, 83.2% vs. 44.9%, P<0.01; CRP ≥10 mg/L, 50.4% vs. 6.0%, P<0.01; LDH ≥ 250 U/L, 73.8% vs. 20.1%, P<0.01; PCT ≥ 0.5 ng/ml, 27.7% vs. 1.8%, P<0.01). Moreover, dynamic tracking showed D-dimer kept increasing in non-survivors, while CRP, LDH and PCT remained relatively stable after admission. D-dimer has the highest C-index to predict in-hospital mortality, and patients with D-dimer levels ≥0.5 mg/L had a higher incidence of mortality (Hazard Ratio: 4.39, P<0.01). Our study suggested D-dimer could be a potent marker to predict the mortality of COVID-19, which may be helpful for the management of patients.

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“…However, we know that a patient with normal initial glycemic profile may develop stress hyperglycemia during the course of illness, especially if the individual moves up the COVID severity ladder. Besides, institution of glucocorticoids for treatment of primary disease may also contribute to hyperglycemia in such an individual [ 29 , 30 ]. Thus, glycemic assessment should be an ongoing dynamic process and not a one-time event ( Fig.…”

Section: Introductionmentioning

confidence: 99%

A guidance on diagnosis and management of hyperglycemia at COVID care facilities in India

Gupta

Goyal

Kubihal

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background and aims Diabetes and coronavirus disease 2019 (COVID-19) share a bidirectional relationship. Hyperglycemia occurring in the setting of either previously diagnosed or undiagnosed diabetes is known to be associated with poor outcomes. Here, we aim to provide a simple and practical guidance on the diagnosis and management of hyperglycemia in admitted patients with COVID-19. Methods The guidance is formulated based on experience of authors and relevant literature on the subject searched using Pubmed. Results Every patient admitted to a COVID care facility should be investigated for hyperglycemia using a combination of tests including capillary blood glucose, fasting plasma glucose and HbA1c. Oral glucose lowering drugs can be considered in patients with mild COVID illness who have mild hyperglycemia (pre-meal blood glucose of ≥180 mg/dl and post-meal blood glucose of ≥250 mg/dl) and no contraindication to the use of these agents. All patients with moderate-severe disease and/or hyperglycemia of greater severity should be initiated on insulin therapy. Hyperglycemia should be aggressively screened for and managed in patients receiving systemic glucocorticoids. Conclusion This document provides a broad overview on the diagnosis and management of hyperglycemia at COVID care facilities and should be useful to a wide range of healthcare personnel involved in care of patients with COVID-19.

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Dexamethasone therapy in COVID‐19 patients: implications and guidance for the management of blood glucose in people with and without diabetes

Cited by 66 publications

References 5 publications

Impact of diabetes on COVID‐19 and other infection: Report from the 22nd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium

Impact of diabetes on COVID‐19 and other infection: Report from the 22nd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium

A cohort study of 676 patients indicates D-dimer is a critical risk factor for the mortality of COVID-19

A guidance on diagnosis and management of hyperglycemia at COVID care facilities in India

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