ABSTRACT
Background: In June 2020, dexamethasone use was approved for hospitalised coronavirus (covid-19) patients in the United Kingdom. Hyperglycaemia in this group has been associated with increased mortality, leading to a national guidance in managing it. Aims: To assess variability in managing hyperglycaemia during dexamethasone therapy and glycaemic outcomes post dexamethasone in covid-19 patients. Method: Retrospective data analysis was performed for 150 dexamethasone-treated covid-19 adult, non-pregnant patients admitted between June and December 2020. We looked at baseline clinical characteristics, adherence to guidance in managing hyperglycaemia and insulin requirement on discharge. Results: Of the 150 patients, 117 (78%) were known to have type 2 diabetes. Of the 27 (18%) not known to have diabetes, 24 had a glycated haemoglobin of 42mmol mol-1 or more, suggesting undiagnosed diabetes and the majority (38%) were White. Prior to dexamethasone, 121 (81%) were not on insulin. After the first dose, 82% had a blood glucose check within 12 hours, 79% had a blood glucose of more than 12mmol l-1 within 24 hours and only 50% had the recommended four times daily blood glucose checks. Of the 121 insulin naive patients, only 52% were managed with the recommended twice daily Neutral Protamine Hagedorn insulin, while 27 (22%) needed insulin on discharge. Of those 27 patients, 44% were White, 26% were Asian and 26% had not declared their ethnicity. Conclusions: Our data show a notable variability in managing hyperglycaemia in dexamethasone-treated covid-19 patients. In this cohort, a high proportion of insulin naive patients required insulin on discharge, suggesting a high risk for progression of diabetes.