Poster Presentation ESA-SRB-APEG-NZSE 2022

Evaluating diurnal glycaemic profiles in patients with COVID-19 treated with dexamethasone: a retrospective observational study (#291)

Shejil Kumar 1 , Ruby Chang 1 , Mariah Melek 1 , Terry Diamond 1
  1. Endocrinology Department, St George Public Hospital, SYDNEY, New South Wales, Australia

Background: COVID-19 and dexamethasone predispose patients to hyperglycaemia, an independent risk factor for severity and mortality in COVID-19 patients. Data is scarce on diurnal glycaemic variation in COVID-19 patients on dexamethasone which could provide key insights into best prevention and management of hyperglycaemia in this population.

Methodology: We conducted a retrospective observational study on 144 patients managed with morning 6mg dexamethasone for COVID-19 at St George Hospital between August 2021 and January 2022. We measured blood glucose levels (BGLs) pre-breakfast, pre-lunch, pre-dinner and bedtime. New diabetes was defined as HbA1c >/= 6.5% or >/= 2 separate episodes of BGL >/= 11.1 mmol/L. Patients admitted to intensive care during dexamethasone course were excluded. We did not analyse influence of diabetes treatment on BGLs.  

Results: Median age was 60 years and 55% were male. Out of the patients with known/newly diagnosed diabetes, 42/43 had T2DM. Incidence of newly diagnosed diabetes was 27% (27/101). Median BGL profile for patients without diabetes was: 6.3 mmol/L pre-breakfast, 7.4 mmol/L pre-lunch, 8.0 mmol/L pre-dinner and 7.5 mmol/L bedtime. In patients with known or newly diagnosed diabetes, median BGL profile for those with HbA1c <7.0% was: 7.6 mmol/L pre-breakfast, 11.1 mmol/L pre-lunch, 12.6 mmol/L pre-dinner and 11.0 mmol/L bedtime. Median BGL profile for those with HbA1c 7-10% was: 7.7 mmol/L pre-breakfast, 13.0 mmol/L pre-lunch, 14.4 mmol/L pre-dinner and 13.3 mmol/L bedtime. Median BGL profile for those with HbA1c > 10% was: 12.2 mmol/L pre-breakfast, 13.9 mmol/L pre-lunch, 14.4 mmol/L pre-dinner and 13.9 mmol/L bedtime. Peak BGL in all cohorts occurred pre-dinner.

Conclusions: We found baseline glycaemic control impacted severity and duration of hyperglycaemia. Only patients with HbA1c >10% experienced persistent hyperglycaemia overnight. HbA1c may guide expected diurnal glycaemic variation in patients with COVID-19 on dexamethasone, which may inform approaches to glycaemic treatment in these patients. 

  1. Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney H, Atkins H, Platts J, Higgins K. New guidance on managing inpatient hyperglycaemia during the COVID-19 pandemic. Diabetic Medicine. 2020 Jun 18;37(7):1210-3.
  2. Alessi J, De Oliveira GB, Schaan BD, Telo GH. Dexamethasone in the era of COVID-19: friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes. Diabetology & Metabolic Syndrome. 2020 Dec;12(1):1-1.
  3. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, Shi J, Zhou M, Wu B, Yang Z, Zhang C. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology. 2020 Jul 1;146(1):110-8.
  4. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, Khare S, Srivastava A. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020 Jul 1;14(4):535-45.
  5. Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, Lei F, Wang H, Xie J, Wang W, Li H. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell metabolism. 2020 Jun 2;31(6):1068-77.
  6. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, Klonoff DC. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. Journal of diabetes science and technology. 2020 Jul;14(4):813-21.
  7. Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, Pérez-Belmonte LM, Hidalgo-Jiménez A, Buonaiuto V, Suárez Fernández C, Freire Castro SJ, Luordo D, Pesqueira Fontan PM, Blázquez Encinar JC. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Annals of medicine. 2021 Jan 1;53(1):103-16.
  8. Zhang F, Karam JG. Glycemic Profile of Intravenous Dexamethasone-Induced Hyperglycemia Using Continuous Glucose Monitoring. The American Journal of Case Reports. 2021;22:e930733-1.