Insulin infusion for hyperglycemia shows link to improved COVID-19 outcomes

  • Sardu C & al.
  • Diabetes Care
  • 19 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In critical care, insulin infusion may help reduce mortality in patients with COVID-19 and hyperglycemia, even in those without diabetes.  

Why this matters

  • No prior data are available about effects on COVID-19 outcomes of tight glycemic control in patients with hyperglycemia.

Study design

  • Evaluation of 59 patients hospitalized with moderate (not ventilated) COVID-19.
  • On admission, 34 were normoglycemic (≤7.77 mmol/L), of whom 8 had a prior diabetes diagnosis.
  • 25 were hyperglycemic (>7.77 mmol/L), including 18 with a diabetes diagnosis. 
  • Funding: Progetti di Ricerca di Interesse Nazionale.

Key results

  • Composite endpoint (severe disease, ICU admission, use of mechanical ventilation, or death) occurred in 13 (52%) patients with admission hyperglycemia and 5 (14.7%) with normoglycemia (P<.01>
  • Among the 25 patients with hyperglycemia, 15 received insulin infusion (11 with diabetes, 4 without).
  • Mean glycemia during hospitalization was 7.69 mmol/L with insulin infusion and 10.65 mmol/L without (P<.001>
  • Composite endpoint occurred in 5 (33%) patients with insulin infusion and 8 (80%) without (P<.01>
  • In risk-adjusted analysis, mortality risk (HRs) from severe disease through 18 days was significantly lower for:
    • No hyperglycemia vs hyperglycemia: 0.285 (P=.044). 
    • No diabetes vs diabetes: 0.172 (P=.004). 
  • Mortality risk was increased with no insulin infusion vs having an infusion: 7.542 (P=.027).

Limitations

  • Small sample.