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接受皮质类固醇治疗的重症 COVID-19 患者的高血糖负担

Burden of Hyperglycemia in Patients Receiving Corticosteroids for Severe COVID-19.

作者信息

Fetters Kirk B, Judge Stephen P, Daar Eric S, Hatlen Timothy J

机构信息

Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA.

Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA.

出版信息

Mayo Clin Proc Innov Qual Outcomes. 2022 Oct;6(5):484-487. doi: 10.1016/j.mayocpiqo.2022.07.004. Epub 2022 Aug 8.

Abstract

Although corticosteroid therapy is the standard of care for all patients hospitalized with severe coronavirus disease 2019 (COVID-19), the studies demonstrating the mortality-benefit ratio of corticosteroids were limited to fully evaluate their adverse effects. To determine the severity of corticosteroid-induced hyperglycemia in patients with and without diabetes mellitus, we retrospectively collected data from the medical records of patients hospitalized with COVID-19 before and after corticosteroids were the standard of care. Corticosteroid-induced hyperglycemia was more severe in patients hospitalized with COVID-19 with diabetes than those without diabetes. Additionally, patients with diabetes required higher doses of correctional insulin per day when on corticosteroid therapy, suggesting that intensive point-of-care glucose monitoring could be limited in patients without diabetes mellitus and support cautionary use of corticosteroids in patients with COVID-19 discharged with supplemental oxygen.

摘要

尽管皮质类固醇疗法是所有因严重2019冠状病毒病(COVID-19)住院患者的标准治疗方法,但证明皮质类固醇死亡率效益比的研究有限,无法全面评估其不良反应。为了确定糖尿病患者和非糖尿病患者中皮质类固醇诱发高血糖的严重程度,我们回顾性收集了在皮质类固醇成为标准治疗方法之前和之后因COVID-19住院患者的病历数据。与非糖尿病患者相比,患有糖尿病的COVID-19住院患者中皮质类固醇诱发的高血糖更为严重。此外,糖尿病患者在接受皮质类固醇治疗时每天需要更高剂量的校正胰岛素,这表明在非糖尿病患者中即时强化血糖监测可能受限,并支持对出院时仍需吸氧的COVID-19患者谨慎使用皮质类固醇。

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