Does high blood sugar worsen COVID-19 outcomes?

Date:
August 11, 2020
Source:
Michigan Medicine - University of Michigan
Summary:
Preliminary observations of COVID-19 patients with diabetes inspired
an algorithm for glucose monitoring that's suspected to help combat
the virus' serious complications.



FULL STORY ==========================================================================
As COVID-19 continues to rage across the U.S., researchers are digging
deeper into how the virus wreaks havoc on the body, especially for those
with a pre- existing chronic illness.


==========================================================================
Now, after preliminary observations of 200 COVID-19 patients with
severe hyperglycemia, a Michigan Medicine team is shedding light in a
new American Diabetes Association paper about why high blood sugar may
trigger worse outcomes in people infected with the virus. And researchers
have developed a blood sugar management tool that may potentially reduce
risk of secondary infections, kidney issues and intensive care stays in
people with diabetes, prediabetes or obesity who get COVID-19.

"Based on preliminary observations of our patients, those with one
of these pre-existing conditions are at high risk for making the
virus-induced respiratory dysfunction much worse, potentially resulting
in death," says first author Roma Gianchandani, M.D., a professor of
internal medicine in the Michigan Medicine division of metabolism, endocrinology and diabetes.

But why? Senior author Rodica Pop-Busui M.D. Ph.D., the Larry. D
Soderquist professor of diabetes, professor of internal medicine and
vice chair of clinical research in the Department of Internal Medicine, suspects it's the low grade, inflammatory nature of diabetes and
hyperglycemia that promote the virus' inflammatory surge, resulting in
insulin resistance and severe hyperglycemia.

"When the body becomes this inflamed, it triggers an abnormal immune
response that instead of just attacking the virus, affects the rest of
the body's healthy cells and tissue, leading to rapid deterioration in
health," she says.



========================================================================== Specifically, these patients are at an increased risk for mechanical ventilation, kidney replacement therapy due to kidney failure and
requiring medications known as vasopressors to stop dangerously low
blood pressure or steroids to combat acute respiratory distress syndrome.

"All of these complications make blood sugar management more difficult,
but our team is convinced this management is essential to prevent
complications that lead to prolonged inpatient stays, or morbidity," Gianchandani says. "A recent study has already shown there's a correlation between well-controlled blood sugar and lower levels of inflammatory
markers." The research team developed a tool to identify and manage
high blood sugar in COVID-19 patients, placing them into certain risk categories that looked at hyperglycemia severity, presence of obesity,
level of insulin resistance, extent of kidney dysfunction and evidence
of rapid changes in inflammatory markers.

Implementing an algorithm The newly created hyperglycemia management teams
set out to find a way to monitor patients' diabetes without having to use
more personal protective equipment to visit the rooms all the time. It
was also important to reduce the health care provider's exposure to the
virus as much as possible.



========================================================================== Although typically accurate, a continuous glucose monitor wouldn't be
as helpful because a patient's low blood pressure and the use of blood
pressure medications could falsely elevate blood sugar levels.

The new protocol called for insulin delivery every six hours, and at
the same time a nurse would check in on the patient. Some patients who
were on ventilators or receiving high doses of Vitamin C would get their arterial or venous blood sugar levels checked, replacing the need for
the team's blood sugar check.

For those with the highest blood sugar levels and severe hyperglycemia,
insulin infusions were an option for patients until their levels fell
between a normal range.

The result of these efforts helped successfully lower blood sugar levels without increasing nurse contact or the overall burden on primary care
teams and PPE usage.

"Improving blood sugar control was important in reducing the amount
of secondary infections and kidney issues this cohort of patients are susceptible to," Gianchandani says. "This might help shorten ICU stays
and lessen the amount of patients that need a ventilator." It's important
to note this algorithm wasn't developed as a result of a clinical trial,
but is based solely on preliminary observations in the patients the
team followed. A larger, randomized and controlled study is necessary
to determine how this algorithm impacts mortality, time to recovery,
the length of ICU stays and rate of severe complications.

"Our team is looking forward to the next steps in confirming our
hypothesis," Gianchandani says. "In the meantime, I think these
observations validate the importance of blood sugar management in COVID-19 patients and can serve as a guide or inspiration for other institutions."
Other members of the hyperglycemia management teams include Nazanene H.

Esfandiari, M.D., Palak Choksi, M.D., Lynn Ang, M.D., Jennifer Iyengar,
M.D.

and Sharon Knotts, NP.


========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Jordyn
Imhoff. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Roma Gianchandani, Nazanene H. Esfandiari, Lynn Ang, Jennifer
Iyengar,
Sharon Knotts, Palak Choksi, Rodica Pop-Busui. Managing
Hyperglycemia in the COVID-19 Inflammatory Storm. Diabetes, 2020;
dbi200022 DOI: 10.2337/ dbi20-0022 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200811163311.htm

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