Risk Factors for Dysglycemia in the Icu during the Covid-19 Pandemic

ABSTRACT

INTRODUCTION: Glycemic control is an important component of quality improvement bundles within the ICU. Dysglycemia among intensive care unit (ICU) patients has been associated with greater morbidity and mortality. The COVID-19 pandemic has been shown to influence hypoglycemia in patients presenting to the emergency department. The purpose of this study is to evaluate risk factors for dysglycemia during the COVID-19 pandemic in critically ill ICU patients on subcutaneous insulin. METHOD(S) Single-center, retrospective quality improvement study of adult critically ill patients admitted to the ICU in 2020. Patients were included if they were on subcutaneous insulin and primarily managed by an intensive care unit multidisciplinary team. Patients were excluded with active endocrinology consultation or receiving intravenous insulin infusion. Rates of hyperglycemia (blood glucose (BG) greater than or equal to 180 mg/dL), severe hyperglycemia (BG > 300 mg/dL), hypoglycemia (less than or equal to 70 mg/dL), or severe hypoglycemia (BG < 54 mg/dL) were evaluated. Basic patient demographics, including history of diabetes, steroid use, COVID-19 diagnosis were obtained. Regression analysis was performed adjusting for age, past medical history of diabetes, use of corticosteroid medications, COVID-19 diagnosis and use of a self-adjusting insulin calculator. RESULT(S) There were 244 adult ICU patients and 2,198 patient days evaluated in this study. History of diabetes was associated with greater odds of hyperglycemia (odds ratio (OR) 2.09 (1.57-2.78), p< 0.01), severe hyperglycemia (OR 1.82 (1.02-3.24), p=0.04), and lower risk for severe hypoglycemia (OR 0.24 (0.07-0.81), p=0.02). Corticosteroid use was associated with greater risk of hyperglycemia (OR 3.04 (2.31-3.99), p< 0.01) and severe hyperglycemia (OR 4.54 (2.59-7.95), p< 0.01), with no significant difference in hypoglycemia. COVID-19 diagnosis was associated with greater hyperglycemia (OR 1.49 (1.11-2), p=0.007) and hypoglycemia (OR 3.93 (1.32-11.73), p=0.01). CONCLUSION(S) In our quality improvement analysis, dysglycemia was found to be more prevalent in patients with corticosteroid use, history of diabetes and patients with a COVID-19 diagnosis. Larger studies would be beneficial to confirm these results.