在COVID-19期间的胰岛素需求轨迹与非COVID-19严重疾病相比-一项回顾性队列研究
Navid Soltani1,2, Henrike Häbel3, Anca Balintescu4,5
1Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Acta anaesthesiologica Scandinavica
|October 15, 2024
概括
危急的COVID-19患者需要更高的胰岛素剂量,并在ICU中表现出较差的血糖控制. 然而,在本研究中,胰岛素与碳水化合物比率 (ICR) 与90天死亡率没有很强的联系.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 传染病 传染病 传染病
背景情况:
- 危急的COVID-19患者的血糖反应尚未得到充分了解.
- 了解胰岛素需求和血糖控制对于管理这些患者至关重要.
研究的目的:
- 评估COVID-19之间的关联,胰岛素需求,血糖控制和重症监护室 (ICU) 患者的死亡率.
- 评估COVID-19对胰岛素与碳水化合物比率 (ICR) 和血糖变异性的影响.
主要方法:
- 对350名COVID-19和1067名非COVID-19的ICU患者进行了回顾性观察研究.
- 胰岛素需求以胰岛素与碳水化合物比率 (ICR) 定义.
- 使用了多变量通用线性混合模型 (GLMM) 和后勤回归分析.
主要成果:
- 与非COVID-19患者 (0.09 U/g) 相比,没有糖尿病的COVID-19患者的平均每日ICR (0.15 U/g) 较高.
- COVID-19与更糟糕的血糖控制有关,包括更高的低血糖患病率,葡萄糖可变性和更低的范围时间.
- 较高的平均ICR显示出90天死亡率增加的趋势 (OR1.77,p=0.076).
结论:
- COVID-19与每克碳水化合物每天胰岛素需求增加以及ICU患者血糖控制较差有关.
- 在ICR和90天死亡率增加之间没有发现强有力的关联.
- 需要进一步的研究来澄清血糖控制和COVID-19危急病例的结果之间的关系.
相关概念视频
Insulin: Dosing Regimen and Adverse Effects
152
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
152
Diabetes Mellitus: Overview and Type I Subtype
2.5K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
2.5K
Hypoglycemia and Glucagon
164
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
164
Diabetes: Management and Pharmacotherapy
238
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
238
Diabetes Mellitus: Type 2 and Gestational
2.2K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.2K
Carbohydrate Metabolism
10.8K
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
10.8K


