Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes

Becker, Christian; Sabang, Ralph Llewel; Cordeiro, Monica F. Nogueira; Hassan, Ibrahim Fawzy; Goldberg, Michael D.; Scurlock, Corey

doi:10.1016/j.amjmed.2020.03.012

Cited by 23 publications

(23 citation statements)

References 32 publications

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“…Thus, as hyperglycemia is commonly reported in critical illness, to ensure a proper control of hyperglycemia through insulin therapy, it is crucial to prevent the occurrence of cardiometabolic complications ( 110 ); therefore, early insulin therapy in critical illnesses, as occur in cases of COVID-19-induced hyperglycemia, may improve the clinical outcomes while reducing the mortality rate through different ways: (a) insulin inhibits pro-inflammatory cytokine linked to ARDS ( 111 ); (b) insulin promotes a restoration of pancreatic and renal ACE2 and ADAM-17 activity, and RAS balance ( 112 ); (c) insulin therapy reduces the risk of hyperglycemia and DKA that are associated with high mortality rates in COVID-19 patients. In addition, insulin therapy exerts a protective role against SARS-CoV-2-induced ALI and ARDS ( 113 ).…”

Section: Diabetic Pharmacotherapy and Covid-19mentioning

confidence: 99%

COVID-19 in Relation to Hyperglycemia and Diabetes Mellitus

Al-Kuraishy¹,

Al-Gareeb²,

Alblihed

et al. 2021

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19), triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), may lead to extrapulmonary manifestations like diabetes mellitus (DM) and hyperglycemia, both predicting a poor prognosis and an increased risk of death. SARS-CoV-2 infects the pancreas through angiotensin-converting enzyme 2 (ACE2), where it is highly expressed compared to other organs, leading to pancreatic damage with subsequent impairment of insulin secretion and development of hyperglycemia even in non-DM patients. Thus, this review aims to provide an overview of the potential link between COVID-19 and hyperglycemia as a risk factor for DM development in relation to DM pharmacotherapy. For that, a systematic search was done in the database of MEDLINE through Scopus, Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Wanfang Data. Data obtained underline that SARS-CoV-2 infection in DM patients is more severe and associated with poor clinical outcomes due to preexistence of comorbidities and inflammation disorders. SARS-CoV-2 infection impairs glucose homeostasis and metabolism in DM and non-DM patients due to cytokine storm (CS) development, downregulation of ACE2, and direct injury of pancreatic β-cells. Therefore, the potent anti-inflammatory effect of diabetic pharmacotherapies such as metformin, pioglitazone, sodium-glucose co-transporter-2 inhibitors (SGLT2Is), and dipeptidyl peptidase-4 (DPP4) inhibitors may mitigate COVID-19 severity. In addition, some antidiabetic agents and also insulin may reduce SARS-CoV-2 infectivity and severity through the modulation of the ACE2 receptor expression. The findings presented here illustrate that insulin therapy might seem as more appropriate than other anti-DM pharmacotherapies in the management of COVID-19 patients with DM due to low risk of uncontrolled hyperglycemia and diabetic ketoacidosis (DKA). From these findings, we could not give the final conclusion about the efficacy of diabetic pharmacotherapy in COVID-19; thus, clinical trial and prospective studies are warranted to confirm this finding and concern.

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Section: Diabetic Pharmacotherapy and Covid-19mentioning

confidence: 99%

COVID-19 in Relation to Hyperglycemia and Diabetes Mellitus

Al-Kuraishy¹,

Al-Gareeb²,

Alblihed

et al. 2021

Front. Cardiovasc. Med.

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“…A plausible explanation for this observation is that the association between hyperglycemia and mortality is most affected by acute stress response, particularly when adjusting for the effect of diabetes [33]. In line with this observation, recent studies reported that hyperglycemia is not significantly associated with mortality after adjustment for disease severity [31,34].…”

Section: Discussionmentioning

confidence: 87%

“…However, the factors associated with ICU dysglycemia are complex [ 36 ]. We simply divided them into endogenous factors (such as age, sex, disease severity, the function of pancreatic beta-cell) and exogenous factors (such as surgical trauma, nutrition therapy, insulin infusion therapy, and use of glucocorticoids) according to previous studies [ 34 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

Guo

Wang

et al. 2021

Acta Diabetol

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Aims Dysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia. Methods This retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis. Result GV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy. Conclusion The association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.

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“…This is in agreement with Temel et al [6] and Callahan and Supinski [28] who revealed that hyperglycemia was a risk factor for ICU-acquired weakness that prolonged the duration of mechanical ventilation. Also, Becker et al [29] found that suboptimal hyperglycemic control (>180 mg/dl) during ICU stay was significantly associated with increased ICU and hospital stay.…”

Section: Discussionmentioning

confidence: 99%