Impact of COVID-19 therapy on hyperglycemia

Abstract

The goal of this study was to analyze the effect of COVID-19 drugs and biologicals on hyperglycemia. A literature search with key terms, such as “COVID-19 drugs and hyperglycemia” and “COVID-19 vaccines and hyperglycemia,” was conducted using PubMed through September 2021. The CDC data were referenced for current COVID-19 profile and statistics. The NIH COVID-19 guidelines were referenced for updated treatment recommendations. Micromedex and UpToDate were used for drug and disease information. Current results suggested that corticosteroids (dexamethasone), remdesivir and antivirals (lopinavir and ritonavir) all have the potential to significantly raise blood glucose levels putting patients at elevated risk for severe complications. In contrary, hydroxychloroquine is associated with hypoglycemia, and tocilizumab decreases inflammation which is associated with improving glucose levels. Other anti-cytokine bioactive molecules are correlated with lower blood glucose in patients with and without diabetes mellitus. Ivermectin, used for mild COVID-19 disease, possesses the potential for lowering blood glucose. Covishield, Pfizer-BioNTech, and Moderna have all been associated with hyperglycemia after the first dose. Individualized /personalized patient care is required for diabetic mellitus patients with COVID-19 infection. Improper drug therapy aggravates hyperglycemic conditions and other comorbid conditions, leading to increased morbidity and mortality.

Evaluation of Remdesivir Utilization Pattern in Critically Ill Patients With COVID-19 in Jazan Province

“…Hospitalized COVID-19 patients requiring intensive care may develop hyperglycemia (an increase in blood glucose {BG}), mainly due to increased glucose production, virus-induced immune response, and insulin resistance [44]. Our study reported a significant decrease (p<0.001) in blood hemoglobin (Hb) levels in 55.7% of patients, which is similar to other findings in the literature [56,57].…”

“…Hospitalized COVID-19 patients requiring intensive care may develop hyperglycemia (an increase in blood glucose {BG}), mainly due to increased glucose production, virus-induced immune response, and insulin resistance [ 44 ]. Moreover, direct SARS-CoV-2 damage to ACE3 BG receptors in pancreatic islets can cause hyperglycemia, even in non-diabetic COVID-19 patients.…”

A Review of Hyperglycemia in COVID-19

“…Systemic corticosteroids are usually used in the treatment of COVID-19 patients who need oxygen therapy [39]. We already know that systemic corticosteroids cause hyperglycemia, especially postprandial glucose, with the dysfunction of pancreatic β-cells, causing IR, which raises the need for insulin therapy [6].…”

“…Although due to the corticosteroids' vital anti-inflammatory effects, there is no other choice but to continue using them in necessary cases, certainly with a controlled dose and duration [39].…”

Susceptibility of Diabetic Patients to COVID-19 Infections: Clinico-Hematological and Complications Analysis

“…In patients with uncontrolled blood glucose who are at risk for diabetes complications, this information may offer recommendations for alternate medications. The healthcare team’s risk/benefit analysis should be applied to this patient population for COVID-19 treatment and prevention recommendations [ 57 ]. In our study, we did not fully evaluate the confounding factors and their impact on the disease outcomes which is a limitation in this study.…”