The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

Introduction Severe COVID‐19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS‐CoV‐2, but evidence to support this is limited. To explore this, we compared insulin requireme...

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Bibliographic Details
Published in:	Endocrinology, Diabetes & Metabolism Diabetes & Metabolism, 2021-07, Vol.4 (3), p.e00228-n/a
Main Authors:	Lockhart, Sam M., Griffiths, Harry, Petrisor, Bogdan, Usman, Ammara, Calvo‐Latorre, Julia, Heales, Laura, Bansiya, Vishakha, Mahroof, Razeen, Conway Morris, Andrew
Format:	Article
Language:	eng
Subjects:	Coronaviruses COVID-19 Data collection Diabetes Glucose Hyperglycemia Hypotheses Insulin insulin resistance Intensive care Original Original s Pneumonia Regression analysis Severe acute respiratory syndrome coronavirus 2 Statistical analysis stress hyperglycaemia Ventilators
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Summary:	Introduction Severe COVID‐19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS‐CoV‐2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID‐19 and non‐COVID‐19 viral pneumonitis. Methods This is a retrospective cohort study of patients with severe COVID‐19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non‐COVID‐19 viral pneumonitis patients was identified from routinely collected audit data. Results Insulin requirements were similar in patients with COVID‐19 and non‐COVID‐19 viral pneumonitis after adjustment for pre‐existing diabetes and severity of respiratory failure. Conclusions In this single‐centre study, we could not find evidence of a unique diabetogenic effect of COVID‐19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre‐existing metabolic disease. Our observational study demonstrates that insulin requirements in patients with severe COVID‐19 are associated with severity of respiratory failure and pre‐existing diabetes. When these features were accounted for, there was no difference in insulin requirements in patients with COVID‐19 or non‐COVID‐19 viral pneumonitis.
ISSN:	2398-9238 2398-9238