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. 2022 Aug;28(8):787-794.
doi: 10.1016/j.eprac.2022.05.006. Epub 2022 May 24.

Assessment of Insulin Infusion Requirements in COVID-19-Infected Patients With Diabetic Ketoacidosis

Daniela Farzadfar  1 , Caitlyn A Gordon  2 , Keith P Falsetta  2 , Tori Calder  3 , Adey Tsegaye  4 , Nina Kohn  5 , Rifka Schulman-Rosenbaum  3
Affiliations

Assessment of Insulin Infusion Requirements in COVID-19-Infected Patients With Diabetic Ketoacidosis

Daniela Farzadfar et al. Endocr Pract. 2022 Aug.

Abstract

Background/objective: Coronavirus disease 2019 (COVID-19) is thought to contribute to diabetic ketoacidosis (DKA) and worse outcomes in patients with diabetes. This study compared the cumulative insulin dose required to achieve DKA resolution in the intensive care unit among patients with type 2 diabetes and COVID-19 infection versus without COVID-19 infection.

Methods: This retrospective cohort study evaluated 100 patients-50 patients with COVID-19 in cohort 1 and 50 patients without COVID-19 in cohort 2-treated with insulin infusions for DKA at a tertiary care teaching hospital. The primary outcome was to compare the cumulative insulin dose required to achieve DKA resolution in each cohort. The secondary outcomes included time to DKA resolution, mean insulin infusion rate, and mean weight-based cumulative insulin infusion dose required to achieve DKA resolution. All endpoints were adjusted for confounders.

Results: The mean cumulative insulin dose was 190.3 units in cohort 1 versus 116.4 units in cohort 2 (P = .0038). Patients receiving steroids had a mean time to DKA resolution of 35.9 hours in cohort 1 versus 15.6 hours in cohort 2 (P = .0014). In cohort 1 versus cohort 2, the mean insulin infusion rate was 7.1 units/hour versus 5.3 units/hour (P = .0025), whereas the mean weight-based cumulative insulin infusion dose was 2.1 units/kg versus 1.5 units/kg (P = .0437), respectively.

Conclusion: COVID-19-infected patients required a significantly larger cumulative insulin dose, longer time to DKA resolution, higher insulin infusion rate, and higher weight-based insulin infusion dose to achieve DKA resolution versus non-COVID-19-infected patients with type 2 diabetes.

Keywords: clinical requirements; coronavirus disease 2019 (COVID-19); diabetic ketoacidosis (DKA); insulin infusion; type 2 diabetes.

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Figures

Fig. 1
Fig. 1
Study enrollment. Flow diagram showing patient inclusion and exclusion. BB = beta-blocker; CCB = calcium channel blocker; COVID-19 = coronavirus disease 2019; DKA = diabetic ketoacidosis; HHS = hyperglycemic hyperosmolar syndrome. aSteroid use prior to or during insulin infusion.
Fig. 2
Fig. 2
Primary endpoint. Adjusted mean cumulative insulin dose (units) required to achieve diabetic ketoacidosis resolution in cohort 1 compared with that in cohort 2. COVID-19 = coronavirus disease 2019.
Fig. 3
Fig. 3
Additional secondary endpoints. Mean insulin infusion rate (units/hour), weight-based cumulative insulin infusion dose (units/kg), and weight-based insulin infusion rate (units/kg/hour) required to achieve diabetic ketoacidosis resolution in cohort 1 compared with that in cohort 2. COVID-19 = coronavirus disease 2019.
See this image and copyright information in PMC

References

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