COVID-19 and diabetes: Insulin requirements parallel illness severity in critically unwell patients

Clin Endocrinol (Oxf). 2020 Oct;93(4):390-393. doi: 10.1111/cen.14288. Epub 2020 Aug 7.

Abstract

Objective: In the light of increased adverse outcomes for people with diabetes affected by COVID-19, we have described the clinical course of a cohort of critically ill patients with COVID-19 and diabetes.

Methods: We retrospectively analysed characteristics, glucometrics and inflammatory markers of patients with diabetes mellitus admitted to intensive care unit (ICU) with COVID-19.

Results: Eight patients with diabetes were admitted to ICU with COVID-19. All had type 2 diabetes, with three being newly diagnosed that admission. Mean HbA1c was 9.2%. Glucometric analysis indicated that extremely high insulin doses were required during peak inflammatory response to maintain glycaemic control with a mean peak insulin requirement of 201 units per day (2.2 units/kg/day).

Conclusions: Critically unwell patients with diabetes mellitus and COVID-19 had high insulin requirements and poorer time in target range at the time of peak inflammatory response, and this improved as their illness resolved.

Keywords: COVID-19; critical illness; diabetes mellitus; insulin.

MeSH terms

  • Adult
  • COVID-19 / complications*
  • Cohort Studies
  • Critical Illness*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / pathology
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Insulin / administration & dosage*
  • Male
  • Middle Aged
  • Retrospective Studies
  • SARS-CoV-2*
  • Severity of Illness Index

Substances

  • Glycated Hemoglobin A
  • Insulin
  • hemoglobin A1c protein, human