Hospitalized COVID-19 patients with diabetes represent more than 20 percent of the population of patients in intensive care units nationwide. Diabetes is a major risk factor for disease severity and mortality in patients with the COVID-19 virus and uncontrolled hyperglycemia – high blood sugar — is associated with longer stays in the hospital and higher death rates.
University of Nebraska Medical Center Andjela Drincic, M.D., and colleagues from across the country, recently published new, international guidelines for hyperglycemia treatment in the hospital setting. The guidelines could reduce the number of deaths and hospital stays in this population.
Co-authors included those from the University of Pittsburgh Medical Center, the University of Washington in Seattle, the Brigham and Women's Hospital and Harvard Medical School in Boston, the University of California in San Francisco, Calif., and the National Institutes of Health in Bethesda, Md.
The manuscript provides guidance for health care providers caring for patients hospitalized for COVID-19 who also have a prior history of diabetes or who have high blood sugar levels at the time of hospitalization. "A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic," recently was published online in the Journal of Clinical Endocrinology & Metabolism, a leading peer-reviewed journal.
"Much has been written about the treatment of patients with COVID-19 in general, but little guidance has been provided to clinicians on how to treat their patients with diabetes," said Dr. Drincic, professor in the UNMC Department of Internal Medicine Division of Division of Diabetes, Endocrine and Metabolism. "And yet, hyperglycemia in this population is rampant and difficult to treat. We thought it was important to offer practicing physicians some guidance on how to address treatment of hyperglycemia, while minimizing exposure to health care workers and protect the use of personal protective equipment."
The paper includes modified protocols for insulin administration, recommendations on bedside glucose monitoring, the use of continuous glucose sensors, virtual glucose management and other aspects of models of care that can be provided by diabetes inpatient services.
She said hospitalized patients with COVID-19 and diabetes need to receive glucose-lowering therapy in addition to other complex medical management as a way of minimizing risk for complications and death. Clinicians also should be aware that some medications used in treating COVID-19 patients, including glucocorticoids and hydroxychloroquine, can affect blood glucose levels, she said.
"We don’t have the details yet, but diabetes is associated with an increased risk of severe bacterial and viral respiratory tract infections. These patients are extremely ill and stress of illness increases insulin resistance and severity of hyperglycemia. Furthermore, they are placed on nutritional support – the majority of whom are on enteral or parenteral nutrition, well-known to cause significant hyperglycemia. High doses of steroids are used to treat these patients which exacerbates hyperglycemia. Since COVID-19 patients with diabetes and uncontrolled hypoglycemia have such poor outcomes, treatment of hyperglycemia is needed and yet it’s challenging."
Dr. Drincic said prevention is the key.
Practicing social distancing, handwashing and wearing masks according to the recommendation by the CDC is important, Dr. Drincic said. "If infected, patients should follow the advice of their doctor, but also understand that significant hyperglycemia is common. Therefore, patients should continue taking their diabetes pills and insulin as prescribed and monitor their blood sugar count frequently and have enough of their diabetes supplies and medications on hand."
The article can be found at https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa342/5851514?searchresult=1.
Dr. Drincic said the American Diabetes Association offers a wealth of helpful and detailed resources for people with diabetes during the coronavirus pandemic.
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