Positive impact of pre-Ramadan education on glycemic control and reducing risk of hypoglycemia in type 2 diabetic elderly patients during COVID 19 pandemic.

BACKGROUND: Elderly patients have higher risks for complications during Ramadan fasting. Educating patients is essential for fasting safely. AIM: To evaluate the impact of pre-Ramadan education in reducing risk of hypoglycemia and achieving glycemic control in elderly. METHODS: A prospective study carried out in outpatients clinics of Internal Medicine department in Assiut university hospital. It included 316 type 2 diabetic patients who intended to fast. They were grouped into 2 groups; < 65 years and ≥ 65 years patients. The patients received pre-Ramadan individual education sessions. A semi-structured questionnaire was used to collect the data to stratify the risk of fasting. The study was carried out in 3 phases. Assessment of hypoglycemia and biochemical parameters after the education was the primary outcome. RESULTS: Fasting blood glucose decreased during and after Ramadan in elderly significantly (p = 0.0001). The patients who achieved fasting blood glucose less than 8 mmol/L increased from 29.3% to 46.6% after Ramadan in elderly patients. HbA1c decreased significantly after Ramadan (p = 0.001). The main cause of breaking fast was hypoglycemia in both groups; 9% vs.7.7% in patients < 65 and ≥ 65 years respectively. The waist circumference showed significant decrease in patient with 65 years old or more (p = 0.05). Total cholesterol and LDL increased with no statistical significance in patients ≥ 65 years (p = 0.512, 0.470). Both groups showed improvement of HDL cholesterol during and after Ramadan (P = 0.0001). CONCLUSION: Pre-fasting education had positive impact on decreasing the risk of symptomatic hypoglycemia in elderly diabetic patients.

Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment.

PURPOSE: Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. METHODS: This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. RESULTS: There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], -0.9 [-1.3, -0.5] mEq/L vs -0.6 [-1.2, -0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. CONCLUSION: Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

High prevalence of Afro-Caribbean ethnicity and hypoglycaemia in patients with diabetes and end stage renal disease hospitalized with COVID-19.

End stage renal disease (ESRD) is associated with a high mortality rate among patients hospitalized with COVID-19. To the best of our knowledge, there is limited data on the clinical features, ethnicity, inpatient glycaemic control and outcomes in patients with diabetes related ESRD in the literature. We report the clinical features and outcomes of 39 consecutive ESRD patients (28 on haemodialysis [HD] and 11 with renal transplant) secondary to diabetic kidney disease admitted to a university hospital with COVID-19. We observed a high prevalence of patients of Afro-Caribbean ethnicity hospitalized with COVID-19 with a 73% and 54% prevalence in renal transplant and HD groups respectively. The mortality rate of our cohort was 36%. Nearly a one-third of HD patients and one-fifth of transplant patients had hypoglycaemic events during COVID-19 hospitalization. Adjustment of diabetes treatment was frequently required. Our data highlight the importance of integrated multidisciplinary care of patients with diabetes related ESRD hospitalized with COVID-19.

Hydroxychloroquine Sulfate Related Hypoglycemia In A Non-Diabetic COVID-19 Patient: A Case Report and Literature Review.

Objective: Hypoglycemia is a serious adverse effect of hydroxychloroquine (HCQ) which is very rare in non-diabetic patients. This case report describes a non-diabetic patient without any other chronic diseases, who experienced mild hypoglycemia related to HCQ used for COVID-19 treatment.Methods: All etiologies causing hypoglycemia were investigated and a 72-hour fast test was performed.Results: A 34-year-old male patient was admitted to our hospital with a high fever, cough, and chest pain. The result of his COVID-19 PCR test was positive. He received HCQ for 10 days for the treatment of COVID-19 infection. He experienced fatigue, dizziness, severe headache, weakness and feeling of hunger after discontinuation of HCQ during his isolation at home. Before COVID-19 infection, he never experienced hypoglycemia symptoms. He did not have a history of chronic diseases, drug use, alcohol consumption, or smoking. A 72-hour fasting test was performed. He complained about headache and weakness during the 72-hour test period. The PG level was determined as 49 mg/dl during these symptoms. Concurrent insulin and C-peptide levels were <2 mU/mL and 0.553 ng/mL, respectively. ACTH, cortisol, growth hormones, liver and kidney function tests were normal. HbA1c level was 4.7% (28 mmol/mol) (Normal Range %4,5-5,7).Conclusion: Hypoglycemia may be observed as an adverse effect of HCQ used for COVID-19 infection even in patients without chronic diseases and comorbidities. We must be careful while using HCQ for these patients and must warn them about this effect. The warning about hypoglycemia effect of HCQ must be added to COVID-19 treatment guidelines.

Blood glucose levels should be considered as a new vital sign indicative of prognosis during hospitalization.

BACKGROUND AND AIMS: The measurement of vital signs is an important part of clinical work up. Presently, measurement of blood glucose is a factor for concern mostly when treating individuals with diabetes. Significance of blood glucose measurement in prognosis of non-diabetic and hospitalized patients is not clear. METHODS: A systematic search of literature published in the Electronic databases, PubMed and Google Scholar was performed using following keywords; blood glucose, hospital admissions, critical illness, hospitalizations, cardiovascular disease (CVD), morbidity, and mortality. This literature search was largely restricted to non-diabetic individuals. RESULTS: Blood glucose level, even when in high normal range, or in slightly high range, is an important determinant of morbidity and mortality, especially in hospitalized patients. Further, even slight elevation of blood glucose may increase mortality in patients with COVID-19. Finally, blood glucose variability and hypoglycemia in critically ill individuals without diabetes causes excess in-hospital complications and mortality. CONCLUSION: In view of these data, we emphasize the significance of blood glucose measurement in all patients admitted to the hospital regardless of presence of diabetes. We propose that blood glucose be included as the "fifth vital sign" for any hospitalized patient.