Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control?
Outcomes in Patients With Hyperglycemia Affected by COVID-19: Can We Do More on Glycemic Control?
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DOI：
10.2337/dc20-0723
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Marfella, Raffaele
中科院分区：
文献类型：
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作者：
Sardu, Celestino;D'Onofrio, Nunzia;Marfella, Raffaele
目的2型糖尿病患者的血糖控制似乎是任何形式感染的一个重要预后因素。目前还没有关于严格血糖控制对高血糖患者2019冠状病毒病（COVID-19）结局的影响的信息。因此，我们研究了最佳血糖控制对COVID-19影响的高血糖患者的影响。研究设计与方法对59例中度疾病住院的COVID-19患者进行评价。根据入院血糖>7.77 mmol/L分为高血糖组和正常血糖组。入院时和住院期间每周评估白细胞介素6 （IL-6）和d -二聚体水平。复合终点为重症、入住重症监护病房、使用机械通气或死亡。结果血糖正常34例（57.6%），高血糖25例（42.4%）。在高血糖组中，7例（28%）和18例（72%）患者在入院前已经诊断为糖尿病，10例（40%）和15例（60%）患者分别接受了不注射胰岛素和注射胰岛素治疗。未注射胰岛素组住院期间血糖平均值为10.65 +/- 0.84 mmol/L，注射胰岛素组血糖平均值为7.69 +/- 1.85 mmol/L。在基线时，高血糖组的IL-6和d -二聚体水平显著高于正常血糖组（P< 0.001）。尽管所有患者都接受了COVID-19感染的标准治疗，但住院期间高血糖患者的IL-6和d -二聚体水平仍然较高。在一项风险调整的Cox回归分析中，高血糖患者和糖尿病患者发生严重疾病的风险都高于无糖尿病和血糖正常的患者。Cox回归分析证明，接受胰岛素输注治疗的高血糖患者发生严重疾病的风险低于未接受胰岛素输注的患者。结论胰岛素输注可能是COVID-19患者实现血糖指标和改善预后的有效方法。
OBJECTIVE An important prognostic factor in any form of infection seems to be glucose control in patients with type 2 diabetes. There is no information about the effects of tight glycemic control on coronavirus disease 2019 (COVID-19) outcomes in patients with hyperglycemia. Therefore, we examined the effects of optimal glycemic control in patients with hyperglycemia affected by COVID-19. RESEARCH DESIGN AND METHODS Fifty-nine patients with COVID-19 hospitalized with moderate disease were evaluated. On the basis of admission glycemia >7.77 mmol/L, patients were divided into hyperglycemic and normoglycemic groups. Interleukin 6 (IL-6) and D-dimer levels were evaluated at admission and weekly during hospitalization. The composite end point was severe disease, admission to an intensive care unit, use of mechanical ventilation, or death. RESULTS Thirty-four (57.6%) patients were normoglycemic and 25 (42.4%) were hyperglycemic. In the hyperglycemic group, 7 (28%) and 18 (72%) patients were diagnosed with diabetes already before admission, and 10 (40%) and 15 (60%) were treated without and with insulin infusion, respectively. The mean of glycemia during hospitalization was 10.65 +/- 0.84 mmol/L in the no insulin infusion group and 7.69 +/- 1.85 mmol/L in the insulin infusion group. At baseline, IL-6 and D-dimer levels were significantly higher in the hyperglycemic group than in the normoglycemic group (P< 0.001). Even though all patients were on standard treatment for COVID-19 infection, IL-6 and D-dimer levels persisted higher in patients with hyperglycemia during hospitalization. In a risk-adjusted Cox regression analysis, both patients with hyperglycemia and patients with diabetes had a higher risk of severe disease than those without diabetes and with normoglycemia. Cox regression analysis evidenced that patients with hyperglycemia treated with insulin infusion had a lower risk of severe disease than patients without insulin infusion. CONCLUSIONS Insulin infusion may be an effective method for achieving glycemic targets and improving outcomes in patients with COVID-19.