He Xingxing, Duan Guangchen, Lu Jingyi, Wang Yaxin, Cai Jinghao, Tong Yiqing, Wu Wei, Ma Xiaojing, Feng Qiming, Zhou Jian
Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China.
Endocrine. 2024 Nov;86(2):556-563. doi: 10.1007/s12020-024-03841-0. Epub 2024 May 31.
Methylprednisolone is widely used during the COVID-19 epidemic. We aimed to evaluate the glucose profile of COVID-19 patients with and without diabetes receiving methylprednisolone.
36 patients with COVID-19 admitted to hospital were included: 17 with and 19 without diabetes. Methylprednisolone 40 mg was administered at about 9:00 a.m. Glucose levels were assessed by blinded intermittently scanned continuous glucose monitoring (isCGM) for an average of 6.8 ± 2.4 days. Excess hyperglycemia was defined as time above range (TAR) > 10.0 mmol/L (TAR) ≥ 25%, or TAR > 13.9 mmol/L (TAR) ≥ 10%.
Glucose management indicator (GMI) was significantly higher than the admission glycated hemoglobin A (HbA) level in patients without diabetes [6.7 (6.1-7.0) % vs. 5.9 (5.9-6.1) %, P < 0.001], while no significant difference was found in patients with diabetes [9.0 (7.5-9.5) % vs. 8.9 (7.5-10.2) %, P > 0.05]. The difference between GMI and HbA (∆GMI-HbA) in patients without diabetes was significantly higher than in patients with diabetes [0.7 (0.2-1.0) % vs. -0.2 (-1.5-0.5) %, P = 0.005]. The circadian patterns of glucose were similar in the two groups. In patients without diabetes, excess hyperglycemia occurred in 31.6% (6/19) of participants, with 31.6% (6/19) having a TAR ≥ 25%, while 21.1% (4/19) had a TAR ≥ 10%.
The impact of methylprednisolone on glycemia was more pronounced in COVID-19 patients without diabetes, compared to those with diabetes. A significant burden of methylprednisolone-induced hyperglycemia was observed in patients without diabetes.
在新型冠状病毒肺炎（COVID-19）疫情期间，甲泼尼龙被广泛使用。我们旨在评估接受甲泼尼龙治疗的合并或未合并糖尿病的COVID-19患者的血糖情况。
纳入36例住院的COVID-19患者：17例合并糖尿病，19例未合并糖尿病。于上午9点左右给予40mg甲泼尼龙。通过盲法间歇性扫描式动态血糖监测（isCGM）评估血糖水平，平均监测6.8±2.4天。血糖过高定义为血糖高于范围的时间（TAR）>10.0mmol/L（TAR）≥25%，或TAR>13.9mmol/L（TAR）≥10%。
未合并糖尿病的患者血糖管理指标（GMI）显著高于入院时糖化血红蛋白A（HbA）水平[6.7（6.1-7.0）%对5.9（5.9-6.1）%，P<0.001]，而合并糖尿病的患者未发现显著差异[9.0（7.5-9.5）%对8.9（7.5-10.2）%，P>0.05]。未合并糖尿病患者的GMI与HbA之差（∆GMI-HbA）显著高于合并糖尿病的患者[0.7（0.2-1.0）%对-0.2（-1.5-0.5）%，P=0.005]。两组血糖的昼夜模式相似。在未合并糖尿病的患者中，31.6%（6/19）的参与者出现血糖过高，其中31.6%（6/19）的TAR≥25%，而21.1%（4/19）的TAR≥10%。
与合并糖尿病的COVID-19患者相比，甲泼尼龙对未合并糖尿病的COVID-19患者血糖水平的影响更为明显。在未合并糖尿病的患者中观察到甲泼尼龙诱导的高血糖负担较重。
