[Dysglycemia in COVID-19 and Type 2 Diabetes Mellitus: Peculiarities of the Glycemic Profile in Hospitalized Patients and the Role of Steroid-Induced Disorders].

BACKGROUND: There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM). AIM: to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment. MATERIALS AND METHODS: We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 without COVID-19 (control group) using a professional 4-7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS. RESULTS: Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range¼ (32.7 ± 20.40 vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods. CONCLUSION: Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5-6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.

Features of COVID-19 course in patients with obesity and dysglycemia

Aim. To study the features of coronavirus disease 2019 (COVID-19) in patients with different severity of carbohydrate metabolism disorders (CMDs), taking into account the possible role of obesity in the acceleration of clinical and laboratory disorders. Material and methods. There were 137 consecutive patients admitted to the infectious disease hospital for COVID-19 patients. Three 3 groups were formed: Group 1 — 42 patients with concomitant type 2 diabetes (T2D);group 2 — 13 patients with concomitant prediabetes;group 3 — 82 patients without concomitant CMDs. Results. Patients with T2D tended to have a more severe disease course according to the SMRT-CO algorithm (p=0,089), which was associated with the longest hospital stay (p=0,038), the most pronounced (p=0,011) and prolonged (p=0,0001) decrease in oxygen saturation, the maximum percentage of lung injury at the beginning (p=0,094) and at the end (p=0,007) of hospitalization, the greater need for intensive care unit (p=0,050), as well as the highest increase in C-reactive protein and fibrinogen (hypercoagulability and systemic inflammation were noted in all groups). Patients with prediabetes in terms of COVID-19 severity occupied an intermediate position between those with T2D and without CMDs;at the same time, they most often needed the prescription of biological preparations (p=0,001). In the first and second groups, there were larger, compared with the control, proportions of obese people (61,9%, 53,8% and 30,5%, respectively, p=0,003). Prediabetes group had a strong correlation between the severity of viral pneumonitis according to SMRT-CO and the presence of obesity (R=0,69, p=0,009). Conclusion. In patients with impaired carbohydrate metabolism of any severity, COVID-19 is more severe. At the same time, persons with overt T2D are prone to the most severe COVID-19 course, while patients with prediabetes in terms of disease severity occupy an intermediate position between them and those without CMDs. Obesity is a strong risk factor for severe COVID-19 among patients with initial CMDs (prediabetes), which is partly mediated by prior liver dysfunction associated with the metabolic syndrome. The increase in proinflammatory changes and hypercoagulability is associated with COVID-19 severity in patients with and without CMDs. These disorders had the greatest severity and persistence in patients with T2D.