RESUMO
Background: Uncontrolled hyperglycaemia before and during hospitalisation is a risk factor for adverse outcomes in people with diabetes and SARS-CoV-2 infection. Insulin often at high doses is frequently required to manage hyperglycaemia associated with SARS-CoV-2 infection during hospitalisation. However, there is limited information on the clinical features and sequelae of people with type 2 diabetes (T2DM) not previously on insulin that require insulin as a new treatment when hospitalised with SARS-CoV-2 infection. Aims: To describe the clinical features and insulin treatment sequelae of 113 people with T2DM that required insulin as a new treatment when hospitalised with SARS-CoV-2 infection. Methods: A single-centre study of 113 people with T2DM who were not on insulin before their admission for SARS-CoV-2 infection. The primary aim of our study was to identify clinical and biochemical features that were associated with the need for insulin as a new treatment in people with known T2DM not on insulin treatment at the time of hospitalisation for SARS-CoV-2 infection. We also describe changes in insulin requirements at time of discharge from hospital and 6 weeks later during the first wave of SARS-CoV-2 infection (April-March 2020) in the UK. Clinical, biochemical, and anthropometric data were collected from electronic health records. Results: We observed that of 113 people with T2DM, 35% (n = 39) needed insulin as a new treatment during their hospitalisation for SARS-CoV-2 infection. People requiring insulin were younger, had a higher preadmission HbA1c, were more frequently on oral medication for diabetes before the admission, and were more likely to be obese (body mass index ≥30 kg/m2), with p ≤ 0.001 for all. In multivariable logistic regression analyses, we observed that younger age and higher HbA1c before admission were independently associated with needing insulin, with one-year increase in age associated with decreased odds of needing insulin initiation (OR 0.91, 95% CI 0.83-0.99), and increasing preadmission HbA1c by 1 mmol/mol associated with an increased odds of insulin initiation (OR 1.05, 95% CI 1.002-1.11) (p < 0.05 for both). Of the 39 people with T2DM who required insulin as a new treatment, 28% remained on insulin at the time of discharge with their insulin dose falling from 1.26 U/kg within the first 7 days of admission to 0.39 U/kg at discharge. At 6 weeks after discharge, 24% of people remained on insulin. Conclusion: More than one-third of people with T2DM not previously treated with insulin required new insulin treatment when hospitalised with SARS-CoV-2 infection, and of this group, 24% remained on insulin at 6 weeks after discharge. This study highlights the important variations of insulin requirements in people with T2DM new to insulin and the importance of a dedicated team for patient education and close follow-up.
RESUMO
PURPOSE OF REVIEW: This systematic review with meta-analysis aims to determine whether maternal outcomes are better with antenatal choice to give birth by caesarean section compared to vaginal birth, in singleton pregnancies in low-risk women without a subsequent pregnancy. The main outcome measures used were as follows: postpartum haemorrhage, postnatal depression, urinary incontinence and maternal mortality. RECENT FINDINGS: There were seven relevant studies (2 730 410 women) that were of high quality, identified for the purpose of this review. Randomized and observational evidence was synthesized, showing no real difference in maternal morbidity risk: maternal mortality (relative risk 0.19, 95% confidence interval 0.0013-27.27, P = 0.51); postpartum haemorrhage (relative risk 1.15, 95% confidence interval 0.40-3.31, P = 0.79) and blood transfusion (relative risk 0.91, 95% confidence interval 0.39-2.13, P = 0.84). SUMMARY: On the basis of the current research and the findings of this review, planned caesarean section is associated with a lower risk of developing urinary incontinence symptoms postpartum or having a blood transfusion yet conversely results showed an increased risk of postpartum haemorrhage. The synthesized data are not applicable to clinical practice; however, they prompt much further investigation into planned delivery and its associated morbidity risk.
