Insulin requirement trajectories during COVID-19 versus non-COVID-19 critical illness-A retrospective cohort study.
COVID‐19
diabetes
insulin
insulin sensitivity
intensive care
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
14 Oct 2024
14 Oct 2024
Historique:
revised:
15
09
2024
received:
28
04
2024
accepted:
02
10
2024
medline:
15
10
2024
pubmed:
15
10
2024
entrez:
15
10
2024
Statut:
aheadofprint
Résumé
The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients. We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality. The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR. In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.
Sections du résumé
BACKGROUND
BACKGROUND
The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients.
METHODS
METHODS
We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality.
RESULTS
RESULTS
The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR.
CONCLUSION
CONCLUSIONS
In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Karolinska Institutet
Organisme : Stockholms Läns Landsting
Informations de copyright
© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Falciglia M, Freyberg RW, Almenoff PL, D'Alessio DA, Render ML. Hyperglycemia‐related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37:3001‐3009.
Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283‐1297.
Dungan KM, Braithwaite SS, Preiser J‐C. Stress hyperglycaemia. Lancet. 2009;373:1798‐1807.
Jernås M, Olsson B, Sjöholm K, et al. Changes in adipose tissue gene expression and plasma levels of adipokines and acute‐phase proteins in patients with critical illness. Metabolism. 2009;58:102‐108.
Gerganova A, Assyov Y, Kamenov Z. Stress hyperglycemia, diabetes mellitus and COVID‐19 infection: risk factors, clinical outcomes and post‐discharge implications. Front Clin Diabetes Healthc. 2022;3:826006.
Reiterer M, Rajan M, Gómez‐Banoy N, et al. Hyperglycemia in acute COVID‐19 is characterized by insulin resistance and adipose tissue infectivity by SARS‐CoV‐2. Cell Metab. 2021;33:2174‐2188.e5.
Gillespie SJ, Kulkarni KD, Daly AE. Using carbohydrate counting in diabetes clinical practice. J Am Diet Assoc. 1998;98:897‐905.
Balintescu A, Palmgren I, Lipcsey M, et al. Prevalence and impact of chronic dysglycemia in intensive care unit patients—a retrospective cohort study. Acta Anaesthesiol Scand. 2021;65:82‐91.
Badawi O, Yeung SY, Rosenfeld BA. Evaluation of glycemic control metrics for intensive care unit populations. Am J Med Qual. 2009;24:310‐320.
Hanna M, Balintescu A, Glassford N, et al. Glycemic lability index and mortality in critically ill patients–a multicenter cohort study. Acta Anaesthesiol Scand. 2021;65:1267‐1275.
Carpenter DL, Gregg SR, Xu K, Buchman TG, Coopersmith CM. Prevalence and impact of unknown diabetes in the ICU. Crit Care Med. 2015;43:e541‐e550.
Kuroda A, Yasuda T, Takahara M, et al. Carbohydrate‐to‐insulin ratio is estimated from 300‐400 divided by total daily insulin dose in type 1 diabetes patients who use the insulin pump. Diabetes Technol Ther. 2012;14:1077‐1080.
Wu L, Girgis CM, Cheung NW. COVID‐19 and diabetes: insulin requirements parallel illness severity in critically unwell patients. Clin Endocrinol. 2020;93:390‐393.
Poole AP, Finnis ME, Anstey J, et al. The effect of a liberal approach to glucose control in critically ill patients with type 2 diabetes: a multicenter, parallel‐group, open‐label randomized clinical trial. Am J Respir Crit Care Med. 2022;206:874‐882.
Noh Y‐H, Lee W‐J, Kim K‐A, et al. Insulin requirement profiles of patients with type 2 diabetes after achieving stabilized glycemic control with short‐term continuous subcutaneous insulin infusion. Diabetes Technol Ther. 2010;12:271‐281.
Xu AY, Wang SH, Duong TQ. Patients with prediabetes are at greater risk of developing diabetes 5 months postacute SARS‐CoV‐2 infection: a retrospective cohort study. BMJ Open Diabetes Res Care. 2023;11:e003257.
Balintescu A, Rysz S, Hertz C, et al. Prevalence and impact of chronic dysglycaemia among patients with COVID‐19 in Swedish intensive care units: a multicentre, retrospective cohort study. BMJ Open. 2023;13:e071330.
Holman N, Knighton P, Kar P, et al. Risk factors for COVID‐19‐related mortality in people with type 1 and type 2 diabetes in England: a population‐based cohort study. Lancet Diabetes Endocrinol. 2020;8:823‐833.
Ali Abdelhamid Y, Kar P, Finnis ME, et al. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta‐analysis. Crit Care. 2016;20:301.
Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short‐term mortality in critically ill patients. Anesthesiology. 2006;105:244‐252.
Lin J, Razak NN, Pretty CG, et al. A physiological Intensive Control Insulin‐Nutrition‐Glucose (ICING) model validated in critically ill patients. Comput Methods Programs Biomed. 2011;102:192‐205.
Eriksson A. Models and Algorithms for Personalized Glycemic Control. DIVA‐PORTAL; 2022. https://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-322031
Crisman M, Lucchetta L, Luethi N, et al. The effect of insulin administration on c‐peptide in critically ill patients with type 2 diabetes. Ann Intensive Care. 2017;7:50.
Rogers AR, Jenkins B. Calorie provision from citrate anticoagulation in continuous renal replacement therapy in critical care. J Intensive Care Soc. 2021;22:183‐186.
Wiesen P, Van Overmeire L, Delanaye P, Dubois B, Preiser J. Nutrition disorders during acute renal failure and renal replacement therapy. J Parenter Enteral Nutr. 2011;35:217‐222.
Druml W. Metabolic aspects of continuous renal replacement therapies. Kidney Int. 1999;56:S56‐S61.