CoViD-19 and T2 diabetes mellitus: A frightening couple

ABSTRACT

Background and Aim: We evaluated the effect of CoViD-19 on the therapy of type 2 diabetic CoViD-19 inpatients (T2DM) during a 3-month period (between November 2020 and February 2021). Materials and Methods: We evaluated 432 in-patients all affected with CoViD-19 pneumonia and T2DM. They were 337 male (78%) and 95 female (22%) with mean age 70± 5 yrs and HbA1c 9±0.7%. Their diabetic therapy, along with antibiotic and steroid therapy was always switched to a basAl bolus regimen wheter they used at home oral, incretin or insulin therapy. Results: The T2DM CoViD-19 pneumonia inpatients had a BMI 28±3 kg/sm and an average of total insulin daily dosage (TDD) at hospitalization of 54±7 IU/day and at discharge of 77±8 IU/day. Initially at hospitalization we performed an i.v insulin infusion protocol to achieve blood glucose values <200 mg/dl for at least 48 hrs in195 pts (45%). The switch to basal bolus insulin therapy was made on the 3rd day of hospitalization. The major amount of insulin was administered before lunch and supper (both covering 40% of TDD) with 20% of TDD at night as basal. The major cause of this increase (40%) of TDD is in part due to the inflammatory state and partly to steroid therapy. We didn't detect any hypoglycemia. Conclusions: We were forced to use an enormous amount of insulin, both iv and on basal bolus regimen to achieve a slight blood glucose control. The need to further evaluate for inpatients the use of other drugs (GLP1-RA) combined to insulin regimen seems appropriate.