Endocr Pract. 2021 Aug 3:S1530-891X(21)01154-X. doi: 10.1016/j.eprac.2021.07.016. Online ahead of print.
BACKGROUND: Well-controlled glucose (i.e. 70-180 mg/dl) has been associated with lower mortality from COVID-19. The addition of dexamethasone to COVID-19 treatment protocols has raised concerns about the potential negative consequences of dexamethasone-induced hyperglycemia.
METHODS: We developed a protocol to guide the management of dexamethasone-induced hyperglycemia in hospitalized patients with COVID-19. Two of the four medical teams managing patients with COVID-19 at a tertiary center used the protocol and the other two teams continued to manage hyperglycemia at the discretion of the treating physicians ("Protocol" and "Control" groups, respectively). The glycemic control and clinical outcomes in 163 patients hospitalized with COVID-19 and dexamethasone-induced hyperglycemia between July 5th and September 30th, 2020 were retrospectively reviewed and compared between the two groups.
RESULTS: Compared to the "Control" group, the "Protocol" group had higher proportions of patients with well-controlled glucose across all pre-meals and bedtime glucose readings throughout the hospitalization. The differences in glycemic control between the two groups were statistically significant for fasting glucose on days 4, 5, and discharge day; pre-lunch glucose on discharge day; pre-dinner glucose on days 3, 5, and discharge day; and bedtime glucose on day 1 (all p<0.05). After adjusting for age, sex, nationality, BMI, Charlson score, and diabetes status; patients in the "Protocol" group were more likely to have well-controlled glucose compared to those in the "Control" group. Moreover, the in-hospital mortality was significantly lower in the "Protocol" group compared to the "Control" group (12.93 and 29.93%, respectively, p=0.01) CONCLUSIONS: The implementation of a protocol to manage dexamethasone-induced hyperglycemia in hospitalized patients with COVID-19 resulted in more patients achieving well-controlled glucose levels and was associated with lower mortality of COVID-19.