Association of protein-calorie intake and clinical outcomes among critically-ill COVID-19 patients: A retrospective study

Background@#Patients admitted due to severe COVID-19 pneumonia are at high risk for malnutrition and worsening of their clinical condition. Patients with type 2 diabetes admitted for COVID-19 pneumonia have an increased risk for poor clinical outcomes. Adequate nutrition is recommended to augment a strong immune response. The American Society of Parenteral and Enteral Nutrition (ASPEN), Philippine Society of Parenteral and Enteral Nutrition (PHILSPEN), European Society of Parenteral and Enteral Nutrition (ESPEN) recommend an energy intake goal of 15-20 kcal/kg actual body weight (ABW) per day or 70-80% of caloric requirements after the acute phase of critical illness, with recommended protein intake of 1.2-2.0 g/kg ABW per day. This study aims to provide an association between calorie and protein intake with negative clinical outcomes.@*Methods@#This is a retrospective cohort study of 55 mechanically ventilated SARS COV-2 RT-PCR positive patients admitted in the critical unit of Chinese General Hospital between April 1, 2020 to December 30, 2020. Clinical profile taken include: sex, age, height weight, BMI, comorbidities, and components of the modified SOFA score and APACHE II score. Calorie and protein intake from day 3 to day 7 of ICU admission were taken. Clinical outcome data were in-hospital mortality, number of days of ICU stay, hospital admission, vasopressor use and mechanical ventilation.@*Results@#Majority of the patients included in the study were male, elderly, overweight, and with comorbidities such as hypertension, diabetes, and chronic kidney disease. Majority of the patients were on mechanical ventilation and on vasopressors for more than 1 week. In-hospital mortality accounted for 65.5% of cases. For patients without diabetes, calorie intake was 16.9 kcal/kg/day and protein intake was 0.72 g/kg/day, while patients with diabetes had a calorie intake of 20.2 kcal/kg/day and protein intake of 0.86 g/kg/day. Based on the 70% cutoff, patients with diabetes were noted to have been provided with more adequate protein (P-value= 0.027). Higher caloric intake was inversely associated with in-hospital mortality among patients younger than 75 years old (P-value=0.026) and among patients with diabetes (P-value=0.003). Higher calorie intake was also significantly associated with decreased duration of pressors among patients with diabetes (P-value=0.021). Higher protein intake positively associated with the number of days admitted among patients with lower modified SOFA scores (P-value=0.041) and among patients with diabetes (P-value=0.021). All other associations did not display significant results (all P-values>0.05).@*Conclusion@#Based on this study, increased caloric intake was associated with increased survival among patients less than 75 years, but no association was found in patients 75 years and older. Among patients with lower mortality risk, increased protein intake was associated with longer duration of hospital stay, however patients with higher risk had higher in-hospital mortality regardless of protein and calorie intake. Among patients with diabetes, higher calorie intake was associated with increased survival and decreased duration of pressor requirement, while increased protein was associated with longer length of hospital stay. Treatment for COVID-19 pneumonia, however, was not established at this time and there was significant in-hospital mortality among these mechanically ventilated patients.

A prospective, randomized, open label, single-centre study for assessment of safety and effectiveness of recombinant human insulin 30/70 + insulin glulisine compared to recombinant human insulin NPH + regular in the management of type 2 diabetes mellitus patients in the Philippines

Background@#The high prevalence of type 2 diabetes mellitus (T2DM) in the Philippines has burdened the health care system. Therefore, we compared the standard of care Insulin 30/70 + Insulin Glulisine (Arm B) to a traditional insulin regimen NPH Insulin + Regular Insulin (Arm A) to test the concept that both insulin regimens provide comparable effectiveness and safety in real-world practice.@*Methods @#This is a ‘proof-of-concept,’ prospective, randomized, open label pragmatic study of 40 consecutive Filipino T2DM patients from October 2015 to June 2016. The primary endpoint was a reduction in HbA1c at 12 weeks. The secondary endpoints were changes in Fasting Plasma Glucose (FPG), Post Prandial Glucose (PPG), Capillary Blood Sugar (CBS), weight and insulin dose at 12 weeks. ANCOVA and Fisher’s exact tests were used.@*Results @#Patients in treatment arm A showed comparable glycemic control to arm B as measured by reductions in HbA1c (2.89% vs. 2.67%; P = 0.657), FPG (65.94 vs. 46.71 mg/dl; P = 0.57), PPG (76.49 vs. 86.96 mg/dl; P = 0.271) and CBS (115.15 vs. 145.95 mg/dl; P = 0.420). Both treatment arms reported similar weight gain (1.92 vs. 1.22 kg), experienced similar incidence of hypoglycemia (7 vs. 6 patients) and adverse events (AE) (8 vs. 8 patients).@*Conclusion @#The traditional combination of NPH Insulin + Regular Insulin offers comparable glycemic control and tolerance as the standard of care without any new safety signals in the Filipino T2DM population. With a lower price, it can be one of the strategies to reduce the fi nancial burden of antidiabetic treatment.