ABSTRACT
The balance between avoiding severe acute respiratory syndrome coronavirus-2 contagion and reducing wider clinical risk is unclear for gestational diabetes mellitus (GDM) testing. Recent recommendations promote diagnostic approaches that limit collection but increase undiagnosed GDM, which potentially increases adverse pregnancy outcome risks. The most sensitive approach to detecting GDM at 24-28 weeks beyond the two-hour oral glucose tolerance test (OGTT) is a one-hour OGTT (88% sensitivity). Less sensitive approaches use fasting glucose alone (≥5.1 mmol/L: misses 44-54% GDM) or asking ~20% of women for a second visit (fasting glucose 4.7-5.0 mmol/L (62-72% sensitive)). Choices should emphasise local and patient decision-making.
Subject(s)
Coronavirus Infections/prevention & control , Diabetes, Gestational/diagnosis , Pandemics/prevention & control , Patient Isolation/methods , Pneumonia, Viral/prevention & control , Pregnancy Complications, Infectious/prevention & control , Prenatal Diagnosis/methods , Adult , Blood Glucose/analysis , COVID-19 , Clinical Decision-Making , Coronavirus Infections/epidemiology , Female , Gestational Age , Glucose Tolerance Test/methods , Humans , Infection Control/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Outcome , Risk AssessmentABSTRACT
OBJECTIVE: In the light of increased adverse outcomes for people with diabetes affected by COVID-19, we have described the clinical course of a cohort of critically ill patients with COVID-19 and diabetes. METHODS: We retrospectively analysed characteristics, glucometrics and inflammatory markers of patients with diabetes mellitus admitted to intensive care unit (ICU) with COVID-19. RESULTS: Eight patients with diabetes were admitted to ICU with COVID-19. All had type 2 diabetes, with three being newly diagnosed that admission. Mean HbA1c was 9.2%. Glucometric analysis indicated that extremely high insulin doses were required during peak inflammatory response to maintain glycaemic control with a mean peak insulin requirement of 201 units per day (2.2 units/kg/day). CONCLUSIONS: Critically unwell patients with diabetes mellitus and COVID-19 had high insulin requirements and poorer time in target range at the time of peak inflammatory response, and this improved as their illness resolved.