Takahashi Yoshihito, Matsuura Hiroshi, Domi Hisaya, Yamamura Hitoshi
Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka, 578-0947, Japan.
Clin Diabetes Endocrinol. 2022 Apr 27;8(1):4. doi: 10.1186/s40842-022-00141-2.
Many patients with severe COVID-19 have impaired glucose tolerance, and steroid therapy is a standard treatment. Thus, good glycemic control is important and correlates with better patient outcomes. We began using a continuous intravenous insulin infusion protocol for glycemic control whose infusion rate changes based on the currently measured value and previous value. This study aimed to evaluate this protocol for COVID-19 patients requiring mechanical ventilation.
This single-center, retrospective, case control study was conducted on all adult patients who required mechanical ventilation for severe COVID-19 pneumonia admitted to our critical care center from April 1, 2020 through June 20, 2021. Blood glucose levels were measured in all patients every 4 h after admission. We started using the insulin infusion protocol from August 1, 2020. Patients before starting the protocol comprised the non-protocol group and those after starting the protocol comprised the protocol group. Blood glucose levels and hypo- or hyperglycemia events were compared between groups. We also surveyed ICU nurses about their experience using the protocol.
During the study period, 173 patients with COVID-19 were admitted. After 15 patients were excluded for several reasons, the study included 158 patients: non-protocol group (n = 14) and protocol group (n = 144). In the initial phase (days 1-2), blood glucose levels of the protocol group were higher compared with the non-protocol group, and as the number of measurements increased, blood glucose levels were gradually brought under control within the target range in the protocol group. Almost no hypoglycemic events (blood glucose < 80 mg/dL) were detected in either group. The rate of hyperglycemia (blood glucose > 300 mg/dL) was about 5-10% in the initial phase in the protocol group and about 10-15% in the early phase (days 3-4) in the non-protocol group. The questionnaire survey revealed that 80% of ICU nurses responded favorably.
This insulin protocol gradually brought the blood glucose level within target levels in severe COVID-19 patients treated with high-dose steroid. Some hyperglycemia events were detected despite patients being under the protocol in the initial phase, and thus, minor modifications of the protocol might be required in the initial phase.
许多重症新型冠状病毒肺炎（COVID-19）患者存在糖耐量受损，而类固醇疗法是标准治疗方法。因此，良好的血糖控制很重要，且与更好的患者预后相关。我们开始使用持续静脉胰岛素输注方案进行血糖控制，该方案的输注速率根据当前测量值和先前值进行变化。本研究旨在评估该方案对需要机械通气的COVID-19患者的效果。
本单中心、回顾性病例对照研究纳入了2020年4月1日至2021年6月20日期间入住我们重症监护中心、因重症COVID-19肺炎需要机械通气的所有成年患者。所有患者入院后每4小时测量一次血糖水平。我们从2020年8月1日开始使用胰岛素输注方案。开始该方案之前的患者组成非方案组，开始该方案之后的患者组成方案组。比较两组之间的血糖水平以及低血糖或高血糖事件。我们还就ICU护士使用该方案的经验进行了调查。
在研究期间，173例COVID-19患者入院。因多种原因排除15例患者后，研究纳入158例患者：非方案组（n = 14）和方案组（n = 144）。在初始阶段（第1 - 2天），方案组的血糖水平高于非方案组，随着测量次数增加，方案组的血糖水平逐渐在目标范围内得到控制。两组几乎均未检测到低血糖事件（血糖 < 80 mg/dL）。方案组初始阶段高血糖（血糖 > 300 mg/dL）发生率约为5 - 10%，非方案组早期（第3 - 4天）约为10 - 15%。问卷调查显示，80%的ICU护士给予了肯定答复。
该胰岛素方案使接受大剂量类固醇治疗的重症COVID-19患者的血糖水平逐渐达到目标水平。尽管患者在初始阶段遵循该方案，但仍检测到一些高血糖事件，因此，可能需要在初始阶段对该方案进行微调。
