Diagnosis and management considerations in steroid-related hyperglycemia in COVID-19: A position statement from the endocrine society of India

Abstract

The current coronavirus disease (COVID-19) pandemic is showing no signs of abatement and result in significant morbidity and mortality in the infected patients. Many therapeutic agents ranging widely between antivirals and anti-inflammatory drugs have been used to mitigate the disease burden. In the deluge of the drugs being used for COVID-19 infection, glucocorticoids (GCs) stand out by reducing mortality amongst in-hospital severe-to-critically ill patients. Health-care practitioners have seen this as a glimmer of hope and started using these drugs more frequently than ever in clinical practice. The fear of mortality in the short term has overridden the concern of adverse long-term consequences with steroid use. The ease of availability, low cost, and apparent clinical improvement in the short term have led to the unscrupulous use of the steroids even in mild COVID-19 patients including self-medication with steroids. The use of GCs has led to the increasing incidence of hyperglycemia and consequent acute complications of diabetic ketoacidosis and mucormycosis in COVID-19 patients. There is an urgent need to dissipate information about optimum management of hyperglycemia during steroid use. In view of this, the Endocrine Society of India has formulated this position statement about the diagnosis and management of hyperglycemia due to the use of GCs in patients with COVID-19 infection.

The relationship between the Geriatric Nutrition Risk Index (GNRI) and the prognosis of COVID-19 in diabetic geriatric patients

“…It is known that diabetic patients are prone to malnutrition due to diet incompatibility and malnutrition due to endocrine dysfunction [20]. The inflammatory response caused by COVID-19 disease and the use of glucocorticoids increase the severity of hyperglycaemia [21]. In this case, we think that it causes hypoalbuminemia and a decrease in the GNRI score in these patients.…”

Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia

“…Patients with coronavirus disease 2019 (COVID‐19) often have impaired glucose tolerance and difficulty in managing blood glucose (BG) as an underlying disease and 1–5 . Hyperglycemia due to disease stress occurs in patients with severe COVID‐19 pneumonia who require mechanical ventilation.…”

“…The various pathophysiological mechanisms for glucocorticoid‐associated hyperglycemia are as follows: increased endogenous glucose production, impaired peripheral insulin sensitivity, reduced peripheral glucose uptake of muscle and adipose tissue, enhanced effects of other counter‐regulatory hormones that increase endogenous gluconeogenesis, and inhibition of the production and secretion of insulin from pancreatic beta‐cells 2,8,9 . Therefore, many patients with severe COVID‐19 pneumonia suffer from hyperglycemia derived from stress caused by a viral infection, comorbidity of diabetes mellitus, parenteral nutrition, and glucocorticoid use 1,2 . Many reports have shown that hyperglycemia in critically ill patients negatively affects prognosis 10–12 .…”

“…Patients with coronavirus disease 2019 (COVID-19) often have impaired glucose tolerance and difficulty in managing blood glucose (BG) as an underlying disease and. [1][2][3][4][5] Hyperglycemia due to disease stress occurs in patients with severe COVID-19 pneumonia who require mechanical ventilation. The "cytokine storm" which occurs in severe COVID-19 is associated with significant insulin resistance and reduced insulin production from the pancreatic beta cells.…”

“…2,8,9 Therefore, many patients with severe COVID-19 pneumonia suffer from hyperglycemia derived from stress caused by a viral infection, comorbidity of diabetes mellitus, parenteral nutrition, and glucocorticoid use. 1,2 Many reports have shown that hyperglycemia in critically ill patients negatively affects prognosis. [10][11][12] Glycemic control may therefore be essential for patients with severe COVID-19 pneumonia in the intensive care unit (ICU).…”