Can glycemic control protect against the worst effects of COVID?

Researchers say new algorithms for monitoring glucose could help combat severe COVID-19-induced complications in patients with diabetes or hyperglycemia.

After a preliminary observation of 200 COVID-19 patients with severe hyperglycemia, a new Diabetes Paper sheds light on why hyperglycemia may cause worse consequences for people infected with the virus.

“This may help shorten ICU stays and reduce the number of patients who need ventilators.”

Researchers are also investigating glycemic control tools that could potentially reduce the risk of intensive care stays in people with diabetes, prediabetes, or obesity suffering from secondary infections, kidney problems, and COVID-19. Was developed.

“Based on our patient’s preliminary observations, patients with one of these pre-existing conditions are at greater risk of worsening viral-induced respiratory dysfunction and potentially death,” says Internal Medicine. Says professor Roma Gianchandani. Department of Michigan Medicine for Metabolism, Endocrinology, Diabetes.

COVID-19 and diabetes

Rodica Pop-Busui, a professor of diabetes, a professor of internal medicine, and a senior author who is vice-chairman of clinical research in internal medicine, says that it is the low-grades of diabetes and hyperglycemia that promote the viral inflammatory surge. Suspected to be inflammatory. Insulin resistance and severe hyperglycemia.

“When the body gets this inflammation, Abnormal immune response Not only does it attack the virus, it affects other healthy cells and tissues in the body, leading to a rapid deterioration in health,” she says.

Specifically, these patients Mechanical ventilation, Renal replacement therapy with renal failure, and medications or steroids known as pressors to stop dangerous hypotension to combat acute respiratory distress syndrome.

“All of these complications make glycemic control difficult, but our team believes that this management is essential to prevent complications that lead to long stays and morbidity for inpatients,” Gianchandani said. say. “Recent studies have already shown a correlation between well-controlled blood glucose levels and low levels of inflammatory markers.”

The research team has developed tools to identify and manage hyperglycemia in COVID-19 patients, including the severity of hyperglycemia, the presence or absence of obesity, the level of insulin resistance, the extent of renal dysfunction, and the rapid changes in Markers of inflammation classified into specific risk categories for review.

Blood glucose monitoring algorithms

The newly established hyperglycemic control team has begun to look for ways to monitor a patient’s diabetes without the need to use personal protective equipment to constantly visit the room. It was also important to reduce health care provider exposure to the virus as much as possible.

Although usually accurate, continuous glucose monitoring is not very useful, as using patients’ hypotensive and blood pressure medications can inadvertently raise blood sugar levels.

The new protocol required insulin to be given every 6 hours, with the nurse seeing the patient at the same time. Some patients on a ventilator or on high doses of vitamin C will have their arterial or venous blood glucose checked, eliminating the need for a team blood glucose check.

For those with the highest blood sugar levels and severe hyperglycemia, insulin infusion was the patient’s option until their levels were within the normal range.

As a result of these efforts, we were able to successfully lower blood glucose levels without increasing nurse contact and overall burden on primary care teams and the use of PPE.

“Improved glycemic control was important in reducing the amount of secondary infections and kidney problems that this cohort of patients were susceptible to,” says Gianchandani. “This may help shorten ICU stays Reduce the number of patients who need a ventilator. “

It is important to note that this algorithm was not developed as a result of clinical trials, but only based on preliminary patient observations followed by the team. A larger, randomized, controlled trial was used to determine how this algorithm affects mortality, time to recovery, length of ICU stay, and incidence of serious complications. Research is needed.

“Our team looks forward to the next step in confirming our hypothesis,” says Gianchandani. “In the meantime, these observations validate the importance of glycemic control in COVID-19 patients and may serve as a guide or inspiration for other institutions.”

Source: University of Michigan