Continuous Glucose Monitoring Profile in COVID-19 Patients with and Without Diabetes Receiving Methylprednisolone

Overview

Journal Endocrine

Specialty Endocrinology

Date 2024 May 31

PMID 38822183

Authors

Xingxing He

Guangchen Duan

Jingyi Lu

Yaxin Wang

Jinghao Cai

Yiqing Tong

Wei Wu

Xiaojing Ma

Qiming Feng

Jian Zhou

Affiliations

Soon will be listed here.

Abstract

Purpose: 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.

Methods: 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%.

Results: 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%.

Conclusion: 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.

References

Li H, Yan B, Gao R, Ren J, Yang J . Effectiveness of corticosteroids to treat severe COVID-19: A systematic review and meta-analysis of prospective studies. Int Immunopharmacol. 2021; 100:108121. PMC: 8413363. DOI: 10.1016/j.intimp.2021.108121. View

Moromizato T, Sakaniwa R, Tokuda Y, Taniguchi K, Shibuya K . Intravenous methylprednisolone pulse therapy and the risk of in-hospital mortality among acute COVID-19 patients: Nationwide clinical cohort study. Crit Care. 2023; 27(1):53. PMC: 9906603. DOI: 10.1186/s13054-023-04337-5. View

Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E . Dexamethasone therapy in COVID-19 patients: implications and guidance for the management of blood glucose in people with and without diabetes. Diabet Med. 2020; 38(1):e14378. PMC: 7436853. DOI: 10.1111/dme.14378. View

Shen Y, Fan X, Zhang L, Wang Y, Li C, Lu J . Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring. Diabetes Care. 2021; 44(4):976-982. PMC: 7985431. DOI: 10.2337/dc20-1448. View

Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R . Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020; 14(4):813-821. PMC: 7673150. DOI: 10.1177/1932296820924469. View

Khunti K, Del Prato S, Mathieu C, Kahn S, Gabbay R, Buse J . COVID-19, Hyperglycemia, and New-Onset Diabetes. Diabetes Care. 2021; 44(12):2645-2655. PMC: 8669536. DOI: 10.2337/dc21-1318. View

Wang J, Meng W . COVID-19 and diabetes: the contributions of hyperglycemia. J Mol Cell Biol. 2020; 12(12):958-962. PMC: 7543402. DOI: 10.1093/jmcb/mjaa054. View

Cheung N . Steroid-induced hyperglycaemia in hospitalised patients: does it matter?. Diabetologia. 2016; 59(12):2507-2509. DOI: 10.1007/s00125-016-4116-z. View

Liu X, Zhu X, Miao Q, Ye H, Zhang Z, Li Y . Hyperglycemia induced by glucocorticoids in nondiabetic patients: a meta-analysis. Ann Nutr Metab. 2014; 65(4):324-32. DOI: 10.1159/000365892. View

10.

Suh S, Park M . Glucocorticoid-Induced Diabetes Mellitus: An Important but Overlooked Problem. Endocrinol Metab (Seoul). 2017; 32(2):180-189. PMC: 5503862. DOI: 10.3803/EnM.2017.32.2.180. View

11.

Gothong C, Singh L, Satyarengga M, Spanakis E . Continuous glucose monitoring in the hospital: an update in the era of COVID-19. Curr Opin Endocrinol Diabetes Obes. 2021; 29(1):1-9. PMC: 8711300. DOI: 10.1097/MED.0000000000000693. View

12.

Shimizu N, Hayashi A, Ito S, Suzuki A, Fujishima R, Matoba K . Clinical feasibility of remote intermittently scanned continuous glucose monitoring in coronavirus disease 2019 patients with and without diabetes during dexamethasone therapy. Endocr J. 2021; 69(5):597-604. DOI: 10.1507/endocrj.EJ21-0540. View

13.

Huang W, Li S, Lu J, Shen Y, Wang Y, Wang Y . Accuracy of the intermittently scanned continuous glucose monitoring system in critically ill patients: a prospective, multicenter, observational study. Endocrine. 2022; 78(3):470-475. PMC: 9559122. DOI: 10.1007/s12020-022-03216-3. View

14.

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

15.

Bergenstal R, Beck R, Close K, Grunberger G, Sacks D, Kowalski A . Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring. Diabetes Care. 2018; 41(11):2275-2280. PMC: 6196826. DOI: 10.2337/dc18-1581. View

16.

Brooks D, Schulman-Rosenbaum R, Griff M, Lester J, Low Wang C . Glucocorticoid-Induced Hyperglycemia Including Dexamethasone-Associated Hyperglycemia in COVID-19 Infection: A Systematic Review. Endocr Pract. 2022; 28(11):1166-1177. PMC: 9354392. DOI: 10.1016/j.eprac.2022.07.014. View

17.

Burt M, Roberts G, Aguilar-Loza N, Frith P, Stranks S . Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab. 2011; 96(6):1789-96. DOI: 10.1210/jc.2010-2729. View

18.

Zhou Y, Zhao Y, Yuan T, Jiang N, Dong Y, Yang Y . HIGH-DOSE GLUCOCORTICOID TREATMENT DOES NOT INDUCE SEVERE HYPERGLYCEMIA IN YOUNG PATIENTS WITH AUTOIMMUNE DISEASES BY CGMS. Endocr Pract. 2017; 24(1):60-68. DOI: 10.4158/EP171820.OR. View

19.

Yuen K, McDaniel P, Riddle M . Twenty-four-hour profiles of plasma glucose, insulin, C-peptide and free fatty acid in subjects with varying degrees of glucose tolerance following short-term, medium-dose prednisone (20 mg/day) treatment: evidence for differing effects on insulin.... Clin Endocrinol (Oxf). 2011; 77(2):224-32. PMC: 3700529. DOI: 10.1111/j.1365-2265.2011.04242.x. View

20.

Rhou Y, Hor A, Wang M, Wu Y, Jose S, Chipps D . Dexamethasone-induced hyperglycaemia in COVID-19: Glycaemic profile in patients without diabetes and factors associated with hyperglycaemia. Diabetes Res Clin Pract. 2022; 194:110151. PMC: 9651935. DOI: 10.1016/j.diabres.2022.110151. View