Maintaining Blood Glucose Levels in Range (70-150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients-A Retrospective Analysis.

Rajat Kapoor,Arianna J Vidger,Nupur Gupta,Harleen Kaur,Lava R Timsina,Judith Jacobi,Swapnil Khare,Omar Rahman,Abby M Pollander

doi:10.3390/jcm9113635

Rajat Kapoor, Arianna J Vidger + Show 7 more

Open Access

https://doi.org/10.3390/jcm9113635

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Abstract

Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.

Highlights

BackgroundUncontrolled hyperglycemia is associated with increased mortality, morbidity, in-hospital stroke mortality, secondary infections, and coronary artery disease in intensive care unit (ICU) patients [1,2,3,4,5,6]
Ninety-three patients were included in the COVID-19 cohort and 469 in the non-COVID-19-related illness cohort
The study identifies the difficulty of blood glucose level control in critically ill COVID-19 patients

Summary

Introduction

BackgroundUncontrolled hyperglycemia is associated with increased mortality, morbidity, in-hospital stroke mortality, secondary infections, and coronary artery disease in intensive care unit (ICU) patients [1,2,3,4,5,6]. Many studies tried to identify optimal blood glucose levels and the tools to achieve them in order to improve mortality within ICU [5,8,9]. Lanspa et al showed that achieving >80% time in range (TIR) of 70−139 mg/dL showed promising outcomes in multi-center ICU patients using a computerized e-Protocol. Achieving this TIR goal was independently associated with lower 30-day mortality in nondiabetic and diabetic with previous good control (HbA1 c ≤ 6.5%), but was not beneficial with prior poor diabetes control [8]. Insulin administration should be guided by validated protocols, and many have suggested computerized programs for consistency and safety [11]

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