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Pay Attention to In-Hospital Glucose to Save Lives in COVID-19

What your doctor is reading on Medscape.com:

APRIL 20, 2020 — Diabetes and hyperglycemia among people without prior diabetes are strong predictors of mortality among hospitalized patients with COVID-19, new research suggests. 

The data suggest that although glycemic control may not be at the forefront of most clinicians’ minds when it comes to COVID-19, it is important, and paying more attention to it could save lives, say the researchers, led by Bruce Bode, MD, of Atlanta Diabetes Associates, Georgia, and colleagues, including employees of Glytec, an insulin management software company.

The results were published online April 17 in the Journal of Diabetes Science and Technology

In the observational study of more than 1000 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, those with diabetes and those with hyperglycemia throughout their stay had a fourfold greater inpatient mortality than those without diabetes or hyperglycemia.

And for those without evidence of diabetes prior to admission who developed hyperglycemia in hospital, mortality was sevenfold greater.

This is the first published report characterizing glycemic control among patients hospitalized with COVID-19 in the United States.

“The coronavirus outbreak has stretched our hospitals and health systems to a point we’ve never experienced before, so it’s understandable that glycemic management may not have been a major point of focus thus far,” said Bode, an advisory board member for Glytec, in a statement.

“This research confirms that diabetes is an important risk factor for dying from COVID-19.”

“It also suggests that patients with acutely uncontrolled hyperglycemia — with or without a diabetes diagnosis — are dying at a higher rate than clinicians and hospitals may recognize,” he added.

Therefore, Bode and colleagues write, “in the absence of evidence to the contrary, clinicians should interpret COVID-19 associated hyperglycemia as a potential indicator of pancreatic islet cell injury and a risk for poor outcome.”

“Clinicians should treat hyperglycemia to achieve [blood glucose] targets < 180 mg/dL for most patients. This equates to basal–bolus insulin therapy in most non-ICU patients and continuous insulin infusion in the critically ill as directed by national guidelines,” they add.

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