Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, GR-11521 Athens, Greece.
Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, GR-10676 Athens, Greece.
Medicina (Kaunas). 2021 Jan 14;57(1):68. doi: 10.3390/medicina57010068.
Critically and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes. With this study we aimed to assess glucose, glycemic gap (GlyG) and insulin secretion/sensitivity measures in patients with Covid-19. We studied, upon admission, 157 patients with Covid-19 (84: in wards and 73: in intensive care units; ICU); 135 had no history of diabetes. We measured blood glucose upon admission as well as glycated hemoglobin (A1c), plasma insulin and C-peptide. We calculated the GlyG and the Homeostasis Model Assessment 2 (HOMA2) estimates of steady state beta cell function (HOMA2%B) and insulin sensitivity (HOMA2%S). Statistical assessment was done with analysis or the Kruskal-Wallis test. Compared to patients in the wards without diabetes, patients with diabetes in the wards, as well as patients in the ICU (without or with diabetes) had higher admission glycemia. The GlyG was significantly higher in patients without diabetes in the ICU compared to patients without diabetes in the wards, while HOMA2%B based on glucose and insulin was significantly higher in the ICU patients compared to patients in the wards. Of all the parameters, HOMA2%S based on C-peptide/glucose was higher in survivors ( = 133). In our series of patients with Covid-19, a substantial number of patients with and without diabetes had admission hyperglycemia and those who were critically ill may have had compromised insulin secretion and lowered sensitivity to insulin. These findings lend credence to reports of association between Covid-19 and hyperglycemia/secondary diabetes.
患有严重和非严重 SARS-CoV-2 感染（Covid-19）的患者可能会出现高于预期的血糖水平，即使没有糖尿病也是如此。本研究旨在评估患有 Covid-19 的患者的葡萄糖、血糖间隙（GlyG）和胰岛素分泌/敏感性指标。我们在入院时研究了 157 例 Covid-19 患者（84 例在病房，73 例在重症监护病房；ICU）；135 例无糖尿病病史。我们测量了入院时的血糖以及糖化血红蛋白（A1c）、血浆胰岛素和 C 肽。我们计算了 GlyG 和稳态模型评估 2（HOMA2）对稳态β细胞功能（HOMA2%B）和胰岛素敏感性（HOMA2%S）的估计值。统计评估采用分析或 Kruskal-Wallis 检验进行。与无糖尿病的病房患者相比，有糖尿病的病房患者以及 ICU 患者（无论有无糖尿病）的入院血糖水平更高。与无糖尿病的病房患者相比，无糖尿病的 ICU 患者的 GlyG 显著更高，而基于葡萄糖和胰岛素的 HOMA2%B 在 ICU 患者中显著高于病房患者。在所有参数中，基于 C 肽/葡萄糖的 HOMA2%S 在幸存者中更高（=133）。在我们的 Covid-19 患者系列中，相当数量的有和没有糖尿病的患者入院时出现高血糖，而那些病情严重的患者可能存在胰岛素分泌受损和胰岛素敏感性降低的情况。这些发现为 Covid-19 与高血糖/继发糖尿病之间的关联提供了依据。
