Ketaroonrut Nuttavadee, Kiertiburanakul Sasisopin, Sriphrapradang Chutintorn
Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
SAGE Open Med. 2024 Mar 20;12:20503121241238148. doi: 10.1177/20503121241238148. eCollection 2024.
To determine the optimal initial insulin dosage for controlling hyperglycemia in COVID-19 patients receiving steroids, an area with limited data.
We retrospectively analyzed 156 COVID-19 patients with steroid-induced hyperglycemia treated with insulin. Patients were categorized by their total daily dose of subcutaneous insulin therapy when starting dexamethasone ⩾6 mg/day or equivalent dose of glucocorticoid: Group A (⩽0.29 units/kg), Group B (0.3-0.49 units/kg), Group C (0.5-0.69 units/kg), and Group B (⩾0.7 units/kg). Treatment failure was defined as mean blood glucose level > 280 mg/dL for two consecutive days after initiating insulin or any blood glucose ⩾ 400 mg/dL.
The mean age was 64 ± 14 years, with 50% male, and a mean body mass index of 26.9 ± 6.9 kg/m. Most had preexisting type 2 diabetes (62%). Mean admission blood glucose and HbA1c were 233 ± 112 mg/dL and 7.8 ± 2.3%, respectively. Group A had the lowest HbA1c (6.7 ± 1.2%), while group D had the highest (9.8 ± 2.5%). Median daily dexamethasone dosage or equivalent was 36 (IQR 16.72) mg, with no significant differences in among groups. Group A had the lowest treatment failure rate. There were no significant differences in treatment failure rate between Groups B, C, and D. Additionally, there were no statistically significant differences in mean BG across the groups: Group A 232 ± 42 mg/dL, Group B 247 ± 57 mg/dL, Group C 247 ± 61 mg/dL, and Group D 227 ± 67 mg/dL ( = 0.2). Group D had a significantly higher rate of level 1 hypoglycemia ( = 0.008), while no differences in clinically significant hypoglycemia (level 2 or 3) were observed between groups.
Among patients requiring TDD ⩾ 0.3 units/kg/day, there was no significant difference in treatment failure rate between Groups B, C, and D. Group D had the highest rate of level 1 hypoglycemia. This initial insulin dosage for hospitalized COVID-19 patients on high-dose steroid therapy should be personalized.
确定在接受类固醇治疗的新冠病毒疾病（COVID-19）患者中控制高血糖的最佳初始胰岛素剂量，这一领域的数据有限。
我们回顾性分析了156例接受胰岛素治疗的类固醇诱导性高血糖的COVID-19患者。根据开始使用地塞米松≥6毫克/天或等效剂量糖皮质激素时皮下胰岛素治疗的每日总剂量对患者进行分类：A组（≤0.29单位/千克）、B组（0.3 - 0.49单位/千克）、C组（0.5 - 0.69单位/千克）和D组（≥0.7单位/千克）。治疗失败定义为开始胰岛素治疗后连续两天平均血糖水平>280毫克/分升或任何血糖≥400毫克/分升。
平均年龄为64±14岁，男性占50%，平均体重指数为26.9±6.9千克/米²。大多数患者有2型糖尿病病史（62%）。入院时平均血糖和糖化血红蛋白（HbA1c）分别为233±112毫克/分升和7.8±2.3%。A组的HbA1c最低（6.7±1.2%），而D组最高（9.8±2.5%）。地塞米松每日剂量中位数或等效剂量为36（四分位间距16.72）毫克，各组之间无显著差异。A组的治疗失败率最低。B组、C组和D组之间的治疗失败率无显著差异。此外，各组之间的平均血糖无统计学显著差异：A组232±42毫克/分升，B组247±57毫克/分升，C组247±61毫克/分升，D组227±67毫克/分升（P = 0.2）。D组1级低血糖发生率显著更高（P = 0.008），而各组之间在临床显著低血糖（2级或3级）方面未观察到差异。
在每日总剂量（TDD）≥0.3单位/千克/天的患者中，B组、C组和D组之间的治疗失败率无显著差异。D组1级低血糖发生率最高。对于接受高剂量类固醇治疗的住院COVID-19患者，这种初始胰岛素剂量应个体化。
