Bhat Salman Zahoor, Wu Jiajun, Perin Jamie, Wang Kunbo, Robinson Matthew L, Garibaldi Brian T, Mathioudakis Nestoras
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Department of Pediatrics, Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
J Clin Endocrinol Metab. 2025 Jun 17;110(7):1846-1853. doi: 10.1210/clinem/dgae734.
Patients with diabetes have higher mortality from COVID-19 compared to the general population. Dexamethasone, a potent glucocorticoid used for moderate to severe COVID-19, can worsen hyperglycemia in patients with diabetes, potentially leading to worse outcomes. The efficacy and safety of use of dexamethasone for COVID-19 in patients with diabetes needs further evaluation.
The study aimed to assess the efficacy and safety of dexamethasone in patients with diabetes hospitalized for COVID-19 infection.
This retrospective study analyzed data from 5 hospitals in the Johns Hopkins Health System collected between March 3, 2020, and June 25, 2022. Propensity score matching was applied to a cohort of patients with diabetes who received dexamethasone and those who did not (controls), and outcomes were compared using Cox proportional hazards regression models.
The primary outcome was time to death within 28 days. The secondary outcome was time to clinical improvement. Additional outcomes included the incidence of hyperglycemic emergencies and subgroup analysis of primary outcomes by clinical severity.
Out of 10,329 patients admitted for COVID-19, 3679 had diabetes, and 2361 met the inclusion criteria. After propensity score matching, 529 patients were analyzed in each group. Survival rates between the dexamethasone and control groups during the 0- to 6-day and 7- to 28-day periods and time to clinical improvement at 28 days did not differ significantly. There was no difference in the incidence of diabetic ketoacidosis or hyperosmolar hyperglycemic state between the groups.
Dexamethasone treatment did not significantly improve survival or time to clinical improvement in patients with diabetes and COVID-19 infection. Further prospective studies are needed to confirm these findings and determine potential mechanisms.
与普通人群相比，糖尿病患者因新冠病毒病（COVID-19）死亡的风险更高。地塞米松是一种用于治疗中度至重度COVID-19的强效糖皮质激素，可使糖尿病患者的高血糖恶化，可能导致更差的预后。糖尿病患者使用地塞米松治疗COVID-19的疗效和安全性需要进一步评估。
本研究旨在评估地塞米松对因COVID-19感染住院的糖尿病患者的疗效和安全性。
这项回顾性研究分析了2020年3月3日至2022年6月25日期间在约翰·霍普金斯医疗系统的5家医院收集的数据。对接受地塞米松治疗的糖尿病患者队列和未接受地塞米松治疗的患者（对照组）应用倾向评分匹配，并使用Cox比例风险回归模型比较结局。
主要结局是28天内的死亡时间。次要结局是临床改善时间。其他结局包括高血糖急症的发生率以及按临床严重程度对主要结局进行亚组分析。
在10329例因COVID-19入院的患者中，3679例患有糖尿病，2361例符合纳入标准。倾向评分匹配后，每组分析529例患者。地塞米松组和对照组在0至6天和7至28天期间的生存率以及28天时的临床改善时间差异均无统计学意义。两组之间糖尿病酮症酸中毒或高渗高血糖状态的发生率无差异。
地塞米松治疗并未显著改善糖尿病合并COVID-19感染患者的生存率或临床改善时间。需要进一步的前瞻性研究来证实这些发现并确定潜在机制。
