Glucagon-like peptide 1 receptor agonists: Inpatient use during the COVID-19 pandemic

ABSTRACT

Introduction: Glucagon-like peptide 1 receptor agonists (GLPIRAs) are increasingly used in the management of type 2 diabetes. There is uncertainty surrounding their use during acute hospitalisation and few data for inpatient outcomes - especially during COVID-19 infection. Methods: Electronic records of all patients using GLPIRAs at the point of hospital admission during the COVID-19 second wave were obtained. Data were collected on COVID-19 status, inpatient glycaemic control, continuation of GLP1RA or reason(s) for discontinuation. Glycaemic control was determined by the number of Good Diabetes Days (GDD), defined as days with no values <4 mmol/L and <1 value >11 mmol/L and >2 tests/day. Results: 101 patients fulfilled the inclusion criteria. 43% of these had GLP1RAs discontinued on admission. Positive COVID-19 infection was seen in 14, and 12 of these were treated with dexamethasone. In those with COVID-19 infection, GLP1RAs were discontinued in 71% compared with 38% without COVID (p=0.12). GDD were seen in 19% of total hospital days in COVID-19 positive patients and 47% in COVID-19 negative patients (p<0.001). In COVID-19 positive patients, continuing GLP1RA was associated with poorer glycaemic control than discontinuation (11% vs 20%, p=0.32). In COVID-19 negative patients, glycaemic control was no different in those continuing and discontinuing treatment (48% vs 45% GDD, p=0.44). Discontinuation of treatment with GLP1RAs on admission to hospital was common. In COVID-19 positive patients, this may be due to reduced efficacy in the context of treatment with highdose steroids but no difference in glycaemic outcomes was seen in non-COVID admissions.