Managing hyperglycemia during the COVID-19 pandemic: Improving outcomes using new technologies in intensive care

Valk, Timothy W.; McMorrow, Carol

doi:10.1177/2050312120974174

Cited by 8 publications

(6 citation statements)

References 98 publications

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“…Insulin is widely used for managing glucose levels during hospitalization in ICU ( 368 , 369 ) where it does seem to reduce mortality, length of stay in ICU, and ventilator dependence in COVID-19 ( 370 ). However, correcting glucose levels in ICU is extremely challenging ( 371 , 372 ), especially in a pandemic situation where hospitals are being overwhelmed and should only be attempted by experienced staff. Insulin protocols for any COVID-19 patient would therefore have to be explored, developed and clinically tested.…”

Section: Resultsmentioning

confidence: 99%

A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19

Logette

Lorin

Favreau

et al. 2021

Front. Public Health

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Section: Resultsmentioning

confidence: 99%

A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19

Logette

Lorin

Favreau

et al. 2021

Front. Public Health

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“…Insulin is widely used for managing glucose levels during hospitalization in ICU, but typically only for diabetic patients (367, 368) where it does seem to reduce mortality, length of stay in ICU, and ventilator dependence with COVID-19 (369). However, its correct adjustment in ICU is extremely challenging (370, 371). Insulin protocols for any COVID-19 patient would therefore have to be explored, developed and clinically tested.…”

Section: Resultsmentioning

confidence: 99%

Elevated Blood Glucose Levels as a Primary Risk Factor for the Severity of COVID-19

Logette

Lorin

Favreau

et al. 2021

Preprint

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SARS-CoV-2 started spreading towards the end of 2019 causing COVID-19, a disease that reached pandemic proportions among the human population within months. The reasons for the spectrum of differences in the severity of the disease across the population, and in particular why the disease affects more severely the aging population and those with specific preconditions are unclear. We developed machine learning models to mine 240,000 scientific papers openly accessible in the CORD-19 database, and constructed knowledge graphs to synthesize the extracted information and navigate the collective knowledge in an attempt to search for a potential common underlying reason for disease severity. The literature repeatedly pointed to elevated blood glucose as a key facilitator in the progression of COVID-19. Indeed, when we retraced the steps of the SARS-CoV-2 infection we found evidence linking elevated glucose to each step of the life-cycle of the virus, progression of the disease, and presentation of symptoms. Specifically, elevations of glucose provide ideal conditions for the virus to evade and weaken the first level of the immune defense system in the lungs, gain access to deep alveolar cells, bind to the ACE2 receptor and enter the pulmonary cells, accelerate replication of the virus within cells increasing cell death and inducing an pulmonary inflammatory response, which overwhelms an already weakened innate immune system to trigger an avalanche of systemic infections, inflammation and cell damage, a cytokine storm and thrombotic events. We tested the feasibility of the hypothesis by analyzing data across papers, reconstructing atomistically the virus at the surface of the pulmonary airways, and performing quantitative computational modeling of the effects of glucose levels on the infection process. We conclude that elevation in glucose levels can facilitate the progression of the disease through multiple mechanisms and can explain much of the variance in disease severity seen across the population. The study proposes diagnostic recommendations, new areas of research and potential treatments, and cautions on treatment strategies and critical care conditions that induce elevations in blood glucose levels.HighlightsPatients with severe COVID-19 commonly present with elevated blood glucose levels.Elevated blood glucose impacts numerous biochemical pathways that can facilitate many steps of the SARS-CoV-2 infection.Elevated blood glucose increases glucose in the pulmonary airway surface liquid (ASL), which breaks down the primary innate antiviral defenses of the lungs and facilitates viral infection and replication.Elevated blood glucose causes dysregulations of the immune response that facilitates the cytokine storm and acute respiratory distress syndrome (ARDS).Elevated glucose levels act synergistically with SARS-CoV-2-dependent inactivation of angiotensin-converting enzyme 2 (ACE2) to escalate the disease to multi-organ failure and thrombotic events.

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“…On the contrary, solutions do not seem obvious. Several experts have suggested continuous glucose monitoring, however this is unlikely to be accessible for the majority of critical care units [20]. What is needed is increased education on the interplay between feed stoppages and insulin infusions (risk of hypoglycaemia) and the varying need for insulin for acute to subacute phases, and with decreasing doses of Dexamethasone.…”

Section: Glucose Controlmentioning

confidence: 99%

Nutritional priorities in patients with severe COVID-19

Puthucheary

Rice

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThe COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. Recent findingsThe current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community.

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Managing hyperglycemia during the COVID-19 pandemic: Improving outcomes using new technologies in intensive care

Cited by 8 publications

References 98 publications

A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19

A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19

Elevated Blood Glucose Levels as a Primary Risk Factor for the Severity of COVID-19

Nutritional priorities in patients with severe COVID-19

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