Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19 infection: A retrospective study
Chertok Shacham et al.,
Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19..,
Medicine, doi:10.1097/md.0000000000032650
Retrospective 359 COVID-19 patients with diabetes in Israel, showing lower mortality in the other treatments group compared to the insulin group, with 80% of the other treatments group receiving metformin. Groups refer to use during hospitalization, however most are likely continuation of existing diabetes treatment.
risk of death, 44.9% lower, RR 0.55, p < 0.001, treatment 39 of 162 (24.1%), control 86 of 197 (43.7%), NNT 5.1, 80% of treatment patients received metformin.
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hospitalization time, 6.7% lower, relative time 0.93, p = 0.50, treatment 162, control 197, 80% of treatment patients received metformin.
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Chertok Shacham et al., 20 Jan 2023, retrospective, Israel, peer-reviewed, 3 authors, study period 1 April, 2020 - 31 March, 2021, this trial compares with another treatment - results may be better when compared to placebo.
Abstract: Medicine
®
Observational Study
Blood glucose control with different treatment
regimens in type 2 diabetes patients hospitalized
with COVID-19 infection
A retrospective study
Elena Chertok Shacham, MDa,* , Nimra Maman, BSb, Avraham Ishay, MDa,c
Abstract
Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous
diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients
during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2
diabetes admitted with COVID-19.
This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups
according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second
group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only
treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs
169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher
in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group
received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic
medications with or without insulin.
Abbreviations: GLP-1 RA = glucagon-like peptide-1 receptor agonists, HbA1c = hemoglobin A1c, SGLT-2 = sodium-glucose
transport protein.
Keywords: COVID-19, diabetes therapy in the hospital, type 2 diabetes
hospitalized, the mortality rate was 28.8% in patients with
diabetes and/or uncontrolled hyperglycemia compared with
6.2% in patients with normoglycemia.[9] In another retrospective study of >7000 COVID-19 patients, the authors noticed
that in COVID-19 patients with preexisting diabetes, well-controlled blood glucose was correlated with reduced risk of allcause mortality and less frequent complications, including
adult respiratory distress syndrome, acute kidney injury, and
septic shock.[10] Hyperglycemia can trigger endothelial damage, and over-inflammation via an increase in the expression of
cytokines, including interleukin-6 and tumor necrosis factor-α
in severely ill COVID-19 patients.[11] Recent studies showed
that patients with uncontrolled type 2 diabetes had reduced
titers of COVID-19 neutralizing antibodies after severe acute
respiratory syndrome coronavirus 2 vaccination and higher
rates of breakthrough COVID-19 infection one year after
vaccination.[12,13]
Insulin is well-established as the most appropriate pharmacologic agent for effectively controlling glycemia in hospitals,
particularly in critically ill patients.[14] Insulin regimens that
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treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
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