Association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital: A retrospective cohort study.
Association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital: A retrospective cohort study.
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DOI：
10.1016/j.jcte.2021.100265
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发表时间：
2021-12
影响因子：
3
通讯作者：
Pasquel FJ
中科院分区：
文献类型：
--
作者：
Lopez-Huamanrayme E;Garate-Chirinos DD;Espinoza-Morales F;Del-Castillo-Ochoa S;Gomez-Noronha A;Salsavilca-Macavilca E;Taype-Rondan A;Pasquel FJ
在低收入和中等收入国家，如秘鲁，关于住院患者血糖控制或抗高血糖治疗策略的信息非常有限。我们在秘鲁一家医院观察到糖尿病和COVID-19患者的高死亡率（39.1%）。入院后，滑动比例胰岛素治疗是糖尿病和COVID-19住院患者最常见的治疗方法。与固定剂量胰岛素治疗方案相比，早期和连续使用滑动比例胰岛素与更高的死亡率相关。在COVID-19大流行的情况下，单独使用滑动比例胰岛素的情况很常见，其早期和持续使用可能与较高的住院死亡率有关，应不鼓励使用。在个体化评估后，建议使用固定剂量胰岛素。评估秘鲁一家医院糖尿病和COVID-19患者的高血糖治疗与死亡率之间的相关性。于2020年3月至7月期间进行了一项回顾性队列研究。个人层面的数据是从一个实现的虚拟平台中提取的。我们纳入了因COVID-19住院的2型糖尿病患者。评估的结局为院内死亡率。关注的自变量为高血糖治疗。我们使用具有稳健方差的泊松回归来获得粗相对风险（RR）和调整后的相对风险（RR）及其95%置信区间（95%CI）。在研究期间因COVID-19住院的1635名患者中，包括248名糖尿病患者。大多数为男性（66.9%），中位年龄为62岁。97例患者在医院死亡（39.1%）。入院时的中位数为222.5 mg/dL。入院后48 h，125例（50.4%）患者接受单用滑动标度胰岛素（SSI），46例（18.5%）患者接受固定剂量胰岛素方案。在校正分析中，住院48小时时发生SSI的患者死亡率高于固定剂量胰岛素组（调整后的RR：1.69; 95% CI：1.01 - 2.83），与转换为固定剂量胰岛素组相比，在随后几天继续接受SSI的患者死亡率更高。（调整后的RR：1.64; 95% CI：1.17 - 2.32）。在接受评估的糖尿病和COVID-19患者中，超过三分之一的人在住院期间死亡。与固定剂量胰岛素方案相比，早期和持续使用滑动量表与较高的死亡率相关。
Very limited information about inpatient glycemic control or anti-hyperglycemic treatment strategies is available from low- and middle-income countries, such as Peru. We observed a high mortality (39,1%) among patients with diabetes and COVID-19 in a Peruvian hospital. After admission, sliding scale insulin therapy was the most common treatment approach for hospitalized patients with diabetes and COVID-19. Early and continuous use of sliding scale insulin alone was associated with higher mortality compared to fixed-dose insulin regimens. In the context of COVID-19 pandemic, the use of the sliding scale insulin alone is frequent and its early and continuous use may be associated with higher in-hospital mortality, its use should be discouraged. Fixed-dose insulin is recommended, after an individualized evaluation. To evaluate the association between hyperglycemia treatment and mortality in patients with diabetes and COVID-19 in a Peruvian hospital. A retrospective cohort study was conducted between March and July 2020. Individual-level data were extracted from an implemented virtual platform. We included patients with type 2 diabetes hospitalized with COVID-19. The assessed outcome was in-hospital mortality. The Independent variable of interest was hyperglycemic treatment. We used Poisson regressions with robust variance to obtain crude and adjusted relative risks (RR) and their 95% confidence intervals (95% CI). Out of 1635 patients hospitalized for COVID-19 during the study period, 248 patients with diabetes mellitus were included. The majority were men (66.9%), the median age was 62 years. Ninety-seven patients died in the hospital (39.1%). The median glycemia on admission was 222.5 mg/dL. At 48 h after hospital admission, 125 patients (50.4%) received sliding scale insulin alone (SSI), 46 (18.5%) received a fixed-dose insulin regimen. In the adjusted analysis, the group with SSI at 48 h of hospitalization had higher mortality than those with fixed-dose insulin (adjusted RR: 1.69; 95% CI: 1.01 – 2.83), and those and who continued with SSI in the following days had higher mortality compared to the group that switched to fixed-dose insulin (adjusted RR: 1.64; 95% CI: 1.17 – 2.32). Among assessed patients with diabetes and COVID-19, more than a third died during hospitalization. Early and continuous use of the sliding scale was associated with higher mortality compared to fixed-dose insulin regimens.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
--
影响因子：
3.7
作者：
Huri, Hasniza Zaman;Permalu, Vishaaliny;Vethakkan, Shireene Ratna
通讯作者：
Vethakkan, Shireene Ratna
影响因子：
29
作者：
Tsai, Sue;Clemente-Casares, Xavier;Winer, Daniel A.
通讯作者：
Winer, Daniel A.
影响因子：
3.7
作者：
Mejía F;Medina C;Cornejo E;Morello E;Vásquez S;Alave J;Schwalb A;Málaga G
通讯作者：
Málaga G
影响因子：
4.5
作者：
Xu, Zihui;Wang, Zhongjing;Gao, Ling
通讯作者：
Gao, Ling