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A Novel Algorithm for the Management of Inpatient COVID-19 Glucocorticoid-Induced Hyperglycemia

Alexander B Karol1, Natalia Viera2, Selassie J Ogyaadu2

  • 1Icahn School of Medicine at Mount Sinai, New York, NY.

Clinical Diabetes : a Publication of the American Diabetes Association
|July 17, 2023
PubMed

Insights

A new insulin protocol for managing glucocorticoid-induced hyperglycemia in hospitalized patients with COVID-19 reduced hypoglycemic events. This approach improved patient safety without increasing insulin use or hyperglycemia.

Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Hospital Medicine

Background:

  • Hyperglycemia is a significant complication in hospitalized patients with coronavirus disease 2019 (COVID-19), associated with worse outcomes.
  • Glucocorticoids, commonly used in COVID-19 treatment, can induce hyperglycemia, complicating patient management.
  • Effective management of glucocorticoid-induced hyperglycemia is crucial for improving morbidity and mortality in COVID-19 patients.

Purpose of the Study:

  • To introduce and evaluate a novel insulin titration protocol for managing glucocorticoid-induced hyperglycemia in hospitalized COVID-19 patients.
  • To assess the protocol's impact on hypoglycemic events, hyperglycemia control, and insulin utilization.
  • To determine the safety and efficacy of the new protocol in a real-world clinical setting.

Main Methods:

  • A retrospective analysis compared 65 patients with COVID-19 and glucocorticoid-induced hyperglycemia managed under a new insulin titration protocol against a matched cohort admitted before protocol implementation.
  • Patients were matched 1:1 based on relevant clinical characteristics.
  • Data on hypoglycemic events, hyperglycemia levels, and insulin requirements were collected and analyzed.

Main Results:

  • The novel insulin titration protocol led to a significant reduction in hypoglycemic events.
  • The protocol did not result in an increase in hyperglycemia.
  • Insulin utilization remained comparable between the protocol group and the pre-protocol group.

Conclusions:

  • The implemented insulin titration protocol is effective in safely managing glucocorticoid-induced hyperglycemia in hospitalized COVID-19 patients.
  • This novel approach reduces the risk of hypoglycemia without compromising glycemic control or increasing insulin dosage.
  • The protocol offers a valuable strategy for improving patient care and outcomes in this vulnerable population.

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