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3 . 2021

Insulin therapy in patients with diabetes mellitus and COVID-19 and its correlation with risk factors for adverse outcomes

Abstract

Aim of the study - to study the features of insulin therapy (IT) in COVID-19 (COronaVIrusDisease 2019) and concomitant diabetes mellitus, as well as to assess its correlation with risk factors for adverse outcomes.

Material and methods. 57 patients with COVID-19 and diabetes mellitus were observed, with average age of 60.2±11.75 years, a body mass index (BMI) of 31.7±5.58 kg/m2, with a predominance of women [39 (68.4%)]. All in-hospital treatment patients were divided into 2 groups: those who did not require (n=35) and those who required (n=22) the prescription of insulin during hospitalization. All patients received antiviral and antibacterial therapy, as well as anticoagulants treatment (enoxaparin was prescribed to each patient to prevent thrombotic complications). 25 (43.9%) patients received glucocorticosteroids (GCS). The assessment of the severity of viral pneumonitis and the need of respiratory support was determined using the SMRT-CO algorithm. The volume of lung tissue damage was assessed by computer tomography, oxygen saturation (SpO2) - by pulse oximetry. Standard methods were used to study C-reactive protein, Hemoglobin A1c, glycemia, and other parameters.

Results and discussion. The average daily insulin dose among patients on IT was 15.6±18.25 units/day. The IT requirement in patients with concomitant pathology increased with the increase of the length and the degree of decompensation of diabetes mellitus, the severity and prevalence of COVID-19-related viral pneumonitis, the intensity of inflammatory disorders, with the use of corticosteroids and dosage increase, as well as with the presence of significant comorbid pathology (primarily, coronary heart disease, CHD).

Conclusion. IT is indirectly associated with unfavorable outcomes in patients with concomitant pathology, due to its frequent association with CHD, pronounced pro-inflammatory shifts and other factors that complicate the course of pneumonitis in COVID-19.

Keywords:diabetes mellitus, COVID-19, C-reactive protein, hyperglycemia, insulin therapy, glucocorticosteroids

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Belikina D.V., Strongin L.G., Nekrasova T.A., Malysheva E.S., Nekrasov A.A. Insulin therapy in patients with diabetes mellitus and COVID-19 and its correlation with risk factors for adverse outcomes. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2021; 10 (3): 8-14. DOI: https://doi.org/10.33029/2304-9529-2021-10-3-8-14 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
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