Thursday , December 9 2021

Blood sugar fluctuations affect patients with diabetes with COVID-19



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Author: Oluwatayo Ishola, PharmD. Candidate, South College, Faculty of Pharmacy

Blood sugar levels of 70 to 160 mg / dL are considered normal and anything outside of these levels can negatively affect patients with diabetes and COVID-19.

According to a study in China, wide variations in glucose levels give patients diagnosed with coronavirus and diabetes a higher risk of developing adverse effects. This research was developed by tracking the blood sugars of patients with diabetes and coronavirus during their hospitalization in Wuhan, China (where the pandemic originated). Therefore, it is recommended to initiate medication therapy in patients with COVID-19 and diabetes with blood glucose levels below 70 or above 160. The goal of initiating therapy is to ensure that the patient’s glucose is within ‘a normal range, thus improving its chances and decreasing its risks of developing adverse effects.

When examining patients ’A1c levels, the researchers determined that these levels may not be a good reference for coronavirus outcomes. A1c may appear normal in test results, even if not, in patients who regularly experience hypoglycemia and hyperglycemia. Due to the potential for a false normal result, A1c is not a good measure of glycemic fluctuation. When monitoring glucose variability in patients, only blood sugar levels should be measured and used.

The study was small and consisted of 35 patients with diabetes. These patients were hospitalized after being diagnosed with coronavirus. Patients with intermittently scanned continuous glucose monitoring (also known as isCGM) were observed. Of the 35 patients who participated in the study, 15 of them were very ill, were admitted to the intensive care unit or carried ventilators. There was no mortality in any of the patients. Patients who met the composite outcome criteria spent more time above blood sugar levels of 140 to 200 mg / dL than other patients. Patients who met the composite outcome criteria spent 52.1 percent of their stay with blood glucose levels above 160 mg / dL, while those who did not pass 29.8 percent of their stay hospital stay exceeded 160 mg / dl. The group of patients who met the composite outcome criteria also spent more of their time with blood sugar levels below 70 than those who did not meet the criteria.

Adjustments had to be made for many patient factors. Factors that required adjustments were glucocorticoid use, age, body mass index, sex, symptoms on admission, and blood pressure. Once the researchers adjusted the study, time spent above the thresholds of 160 to 200 mg / dL and below 70 mg / dL was directly related to an increased risk of coronavirus adverse compound results and a stay prolonged hospitalization. The average hospital stays of patients who reached the thresholds set above were more than one month. Patients who obtained the compounded result also experienced a higher mean glucose level, as seen in their isCGM. With all data presented, there was no statistical significance between glucose levels and adverse compound outcomes in patients with diabetes and COVID-19.

The increased risk of poor outcomes in patients with diabetes and coronavirus is thought to be due to abnormal humoral immunity, decreased T cell function, and dysfunctional neutrophils. Because patients with diabetes are at increased risk for COVID-19-associated side effects, they should do their best to prevent their capture. Aside from taking regular COVID-19 precautions, such as always wearing a mask, socially distancing yourself, and washing your hands, patients should also manage their disease status to mitigate the risks. Patients should continue to check their blood sugar regularly, adhere to medication regimens, exercise regularly, and maintain a healthy weight and dietary habits.

Practice pearls:

  • Patients with diabetes with blood sugar levels below 70 mg / dL and above 160 mg / dL have an increased risk of adverse outcomes due to COVID-19.
  • The researchers believe the increased risk of poor outcomes in patients with diabetes and coronavirus is due to abnormal humoral immunity, decreased T cell function, and dysfunctional neutrophils.
  • Patients with diabetes should continue to manage their condition well to decrease the risks associated with COVID-19.

Miriam E. Tucker. Global glucose changes are equally poor: COVID-19 results in hospitalized patients with diabetes. Medscape, February 25, 2021.

Yun Shen, Fan of Xiaohong, Blood glucose thresholds and COVID-19 results complicated with diabetes: A retrospective exploratory study using continuous glucose monitoring. American Diabetes Association, February 2021.

Oluwatayo Ishola, pharmacist. Candidate, South College, Faculty of Pharmacy

See more information on diabetes and COVID-19.

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