COVID-19 and Diabetes #ATTD2022
My #ATTD2022 experience was nothing but phenomenal and something that I feel the entire diabetes community should have had access to if they could! A conference with over 4000 participants from across 100 nations or so. Here are my greatest take-home messages from amazing professionals (HCPs, Professors, and Researchers, PwD, Industry expertise) with their awesome insights that cannot be fathomed or compressed in a single post, however, enjoy as we continue to #payitforward as the #dedoc°voices!
- Diabetes is associated with a higher risk of: hospitalizations; longer hospital stays; ICU admission; death,
- Morbidity and mortality are age-dependent and 30% higher in men compared to women (this is true even in the general population without diabetes),
- The risk for hospitalization is elevated in both T1D as well as T2D,
- Women with COVID-19 diagnosis were at higher risk for: Preeclampsia/eclampsia; severe infection; ICU admission; Maternal mortality; Preterm birth and Neonatal complications
- Mortality is 2-3 folder higher in people with diabetes. Similarly, morbidities are also higher in people with diabetes,
- Mortality is higher in T1D compared to T2D,
- Age, male sex, glycemic control, multiple comorbidities, and race/ethnicity are associated with higher mortality,
- Pregnancy with diabetes is associated with adverse maternal and fetal outcomes.
With COVID-19 Patients, there are unique Glycemic Management Challenges:
- People with diabetes are at risk of worse outcomes (40% of COVID deaths were in patients with diabetes);
- Steroid use contributes to hyperglycemia (80% of patients in the hospital with COVID are on steroids);
- COVID creates challenges for GM treatment (PPE preservation led to less frequent BG checks);
- Patients with uncontrolled hyperglycemia and no previous diabetes diagnosis had a mortality rate of 41.7% (7 times greater than patients with no diabetes or hyperglycemia);
- Patients with uncontrolled hyperglycemia or diabetes diagnosis, who survived to discharge, had an average Loss of stay of 5.7 days- 1.4 days longer than patients with no diabetes or hyperglycemia
NB. Timely treatment saves lives (Non-ICU patients with severe hyperglycemia 48-72 hours after admission had a mortality rate 7 times higher than those achieving target blood glucose levels).
- Timely treatment of hyperglycemia is a critical component of COVID patient care.
- Hyperglycemia on admission is a marker for worse outcomes, and good glycemic management during the hospital stay leads to better outcomes.
Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes. Despite an increase in DKA hospitalization rates, the age-adjusted DKA, in-hospital case-fatality rate has declined over time. However, with the advent of coronavirus disease (COVID-19), a suspected increase in the frequency and severity of DKA has been hypothesized.
Diabetes Care in the Hospital, as was suggested by the Standards of Medical Care in Diabetes (American Diabetes Association, 2022):
- Insulin should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin dosage based on glycemic fluctuations;
- Insulin therapy should be initiated for the treatment of persistent hyperglycemia starting at a threshold ≥180 mg/dL (10.0 mmol?L) (checked on two occasions). Once insulin therapy is started, a target glucose range of 149-180 mg/dL (7.8-10.0 mmol/L) is recommended for the majority of critically ill and non-critically ill patients;
- More stringent goals, such as 110-140 mg/dL (6.1-7.8 mmol/L), may be appropriate for selected patients if they can be achieved without significant hypoglycemia;
- Basal insulin or basal plus bolus correction insulin regimen is the preferred treatment for non-critically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth;
- An insulin regimen with basal, prandial, and correction components is the preferred treatment for non-critically ill hospitalized patients with good nutritional intake;
- The use of only a sliding scale insulin regimen in the inpatient hospital setting is strongly discouraged.
NB. The COVID-19 vaccine will likely become a routine part of the annual preventive schedule for people with diabetes.
The danger of Hyperglycemia during COVID-19:
- Data suggest that patients with diabetes and poor glycemic control before infection might have an increased risk of COVID-19 related mortality;
- Among 7 300 cases of COVID-19, type 2 diabetes is associated with a higher death rate, but type 2 diabetes persons with better-controlled blood glucose die at a rate lower than those with poorly controlled blood glucose;
- During the COVID-19 pandemic, continuous glucose monitoring is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy;
- Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels >160 mg/dL and 70 mg/dL and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients;
- Diabetes and hyperglycemia do not affect the kinetics and durability of the neutralizing antibody response to SARS-CoV-2. These findings provide the rationale to include patients with diabetes in the early phase of the vaccination campaign against SARS-CoV-2;
- COVID-19 patients with type 2 diabetes may not undergo seroconversion even after two weeks of diagnosis. Impaired seroconversion could theoretically increase the risk of reinfections in patients with diabetes mellitus (DM). However, the studies still require further validation in large-scale studies involving serial estimations of anti-SARS-CoV-2 antibodies in patients with and without diabetes;
- Hyperglycemia at the time of vaccination worsens the immunological response;
- Achieving adequate glycemic control during the post-vaccination period improves the immunological response.
- People with diabetes are more prone to a serious prognosis when affected by COVID-19;
- Optimizing glycemic control is the key to overall treatment in people with diabetes and COVID-19;
- The possible side effects of hypoglycemia agents must be considered during the evolution of the disease;
- Other specific aspects of disease management should be taken into account (e.g. thrombosis);
- The effect of vaccines on diabetes is conditioned by glycemic control.