Managing Hyperglycemia in the COVID-19 Inflammatory Storm

Gianchandani, Roma; Esfandiari, Nazanene H.; Ang, Lynn; Iyengar, Jennifer J.; Knotts, Sharon; Choksi, Palak; Pop‐Busui, Rodica

doi:10.2337/dbi20-0022

Cited by 119 publications

(114 citation statements)

References 24 publications

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“…Fasting glucose was recorded from standard morning fasting blood biochemistry. The median length of hospital stay for nonsurvivors in our cohort was 17 days (interquartile range [IQR] [14][15][16][17][18][19][20][21][22], and patients often suffered sepsis and multiple organ injury during the 2nd week after admission according to our observations and a recent report (5). These conditions resulted in dramatic increases in glucose.…”

Section: Fasting Blood Glucose Parameterssupporting

confidence: 54%

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

Chen

Sun

et al. 2021

Diabetes Care

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To investigate the association of in-hospital early-phase glycemic control with adverse outcomes among inpatients with coronavirus disease 2019 in Wuhan, China. RESEARCH DESIGN AND METHODSThe study is a large case series, and data were obtained regarding consecutive patients hospitalized with COVID-19 in the Central Hospital of Wuhan between 2 January and 15 February 2020. All patients with definite outcomes (death or discharge) were included. Demographic, clinical, treatment, and laboratory information were extracted from electronic medical records. We collected daily fasting glucose data from standard morning fasting blood biochemistry to determine glycemic status and fluctuation (calculated as the square root of the variance of daily fasting glucose levels) during the 1st week of hospitalization. RESULTSA total of 548 patients were included in the study (median age 57 years; 298 [54%] were women, and n 5 99 had diabetes [18%]), 215 suffered acute respiratory distress syndrome (ARDS), 489 survived, and 59 died. Patients who had higher mean levels of glucose during their 1st week of hospitalization were older and more likely to have a comorbidity and abnormal laboratory markers, prolonged hospital stays, increased expenses, and greater risks of severe pneumonia, ARDS, and death. Compared with patients with the lowest quartile of glycemic fluctuation, those who had the highest quartile of fluctuation magnitude had an increased risk of ARDS (risk ratio 1.97 [95% CI 1.01, 4.04]) and mortality (hazard ratio 2.73 [95% CI 1.06, 7.73]). CONCLUSIONSThese results may have implications for optimizing glycemic control strategies in COVID-19 patients during the early phase of hospitalization.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ravaged more than 200 countries and areas since it was first discovered in December 2019. The outbreak and worldwide spread of SARS-CoV-2 have resulted in a global pandemic of coronavirus disease 2019 (COVID-19) with over tens of millions infections and nearly 1 million deaths as of September 2020 (1).Previous studies have demonstrated that the presence of underlying diseases is common and may predispose a patient to poorer or fatal conditions after COVID-19

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Section: Fasting Blood Glucose Parameterssupporting

confidence: 54%

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

Chen

Sun

et al. 2021

Diabetes Care

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“…Second, patients with a diagnosis of diabetes, either comorbid or newly diagnosed, with better controlled blood glucose levels had less severe COVID-19 pneumonia and lower mortality risk compared with those with poorly controlled blood glucose during hospitalisation [38]. This suggests that improving glucose control could be a critical measure to improve outcomes in patients with COVID-19 pneumonia and strongly supports the need for an algorithm for hyperglycaemia treatment, validated through a randomised clinical trial [39]. Third, intensity of diabetes treatment in patients with comorbid diabetes was associated with higher mortality risk.…”

Section: Discussionmentioning

confidence: 77%

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

et al. 2020

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Aims/hypothesis The aim of the study was to characterise the humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with diabetes. Demonstrating the ability to mount an appropriate antibody response in the presence of hyperglycaemia is relevant for the comprehension of mechanisms related to the observed worse clinical outcome of coronavirus disease 2019 (COVID-19) pneumonia in patients with diabetes and for the development of any future vaccination campaign to prevent SARS-CoV-2 infection. Methods Using a highly specific and sensitive measurement of antibodies by fluid-phase luciferase immunoprecipitation assays, we characterised the IgG, IgM and IgA response against multiple antigens of SARS-CoV-2 in a cohort of 509 patients with documented diagnosis of COVID-19, prospectively followed at our institution. We analysed clinical outcomes and antibody titres according to the presence of hyperglycaemia, i.e., either diagnosed or undiagnosed diabetes, at the time of, or during, hospitalisation. Results Among patients with confirmed COVID-19, 139 (27.3%) had diabetes: 90 (17.7%) had diabetes diagnosed prior to the hospital admission (comorbid diabetes) while 49 (9.6%) had diabetes diagnosed at the time of admission (newly diagnosed). Diabetes was associated with increased levels of inflammatory biomarkers and hypercoagulopathy, as well as leucocytosis and neutrophilia. Diabetes was independently associated with risk of death (HR 2.32 [95% CI 1.44, 3.75], p = 0.001), even after adjustment for age, sex and other relevant comorbidities. Moreover, a strong association between higher glucose levels and risk of death was documented irrespective of diabetes diagnosis (HR 1.14 × 1.1 mmol/l [95% CI 1.08, 1.21], p < 0.001). The humoral response against SARS-CoV-2 in patients with diabetes was present and superimposable, as for timing and antibody titres, to that of non-diabetic patients, with marginal differences, and was not influenced by glucose levels. Of the measured antibody responses, positivity for IgG against the SARS-CoV-2 spike receptor-binding domain (RBD) was predictive of survival rate, both in the presence or absence of diabetes. Conclusions/interpretation The observed increased severity and mortality risk of COVID-19 pneumonia in patients with hyperglycaemia was not the result of an impaired humoral response against SARS-CoV-2. RBD IgG positivity was associated Electronic supplementary material The online version of this article (

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“…The same was true for younger patients <50 years requiring prolonged hospital stay (five of 18, 27.7%). Patients with diabetes mellitus are known to have severe COVID-19 infection with adverse outcome; the infection itself can hinder effective glycaemic control, necessitating close monitoring and careful management in diabetic patients [10]. Several studies have found an association between diabetes and ARDS, CCU admission, and death in patients with COVID-19 [11,12].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Oxygen Therapy Post COVID-19 Infection: Factors Leading to the Risk of Poor Outcome

Ray¹,

Chaudhry²,

Rai³

et al. 2021

Cureus

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Background: Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-stranded ribonucleic acid (RNA) β-coronavirus. Prolonged duration of symptoms, ill health, disability, and need for hospitalisation are all well-known features of severe COVID-19 disease. Objective: To describe the epidemiological, clinical and imaging characteristics of hospitalised patients of COVID-19 who required prolonged oxygen therapy after testing negative for SARS-CoV-2 and attempt to determine the associated factors leading to delayed recovery, failure to wean, and mortality. Material and Method: Prospective observational study from 9th September to 6th November 2020 in a tertiary care COVID hospital of Jharkhand. Included COVID-19-infected patients requiring oxygen to maintain a saturation of ≥95% after testing reverse transcription polymerase chain reaction (RT-PCR) negative. Patients were classified as Group I, those who could be weaned off oxygen, and Group II, those who could not be weaned off oxygen during their stay in the isolation ward. A detailed assessment for outcome in these two groups related to age, gender, presence or absence of co-morbidities, nature of co-morbidities and findings of high-resolution CT (HRCT) thorax was done to ascertain risk factors for failure to wean and adverse outcomes. Results: During the study period, 93 patients suffering from moderate to severe COVID-19 infection, could not be discharged from the hospital and were admitted to the post-COVID isolation ward after testing RT-PCR negative, due to breathlessness and need for oxygen therapy, with a male predominance, M:F ratio of 2.2:1. Of these 93 patients, 51 could be weaned off oxygen in the isolation ward. The mean and median age of patients who could be successfully weaned was 58.5±14.3 years and 60 years respectively, compared to a mean age of 64±12.4 years and a median age of 67 years for patients who could not be weaned off oxygen during the isolation period. Patients aged ≥60 years were at risk for prolonged requirement of oxygen compared to those <50 years of age, relative risk (RR) 1.43 (95%CI 0.9-2, p=0.051). Failure to wean in <50 years was noted in presence of co-morbidities, RR 4 (95%CI 1.5-10.6, p=0.005). Multivariable logistic regression analysis calculated an odds ratio (OR) of 12.22 (95%CI 2.4-61.5, p<0.002) in patients of coronary artery disease (CAD), and 3.34 (95%CI 1.01-10.9, p<0.046) in patients of diabetes, for failure to wean with delayed recovery in patients aged 50 years and more, having multiple co-morbidities. Presence of ≥three comorbid conditions was associated with increased risk of critical care unit (CCU) admissions (RR 2.1, p=0.02), failure to wean (RR 1.79, p<0.006), and death (p=0.02). Elderly male patients (mean age of 81.3±7.2years) with CAD and multiple comorbidities were at a high risk of mortality (p=0.01). Conclusion: Patients ≥50 years of age having ≥three co-morbidities are at increased risk of prolonged hospitalisation and oxygen t...

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Managing Hyperglycemia in the COVID-19 Inflammatory Storm

Cited by 119 publications

References 24 publications

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

Association of Early-Phase In-Hospital Glycemic Fluctuation With Mortality in Adult Patients With Coronavirus Disease 2019

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

Prolonged Oxygen Therapy Post COVID-19 Infection: Factors Leading to the Risk of Poor Outcome

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