High blood sugar may worsen COVID-19 outcomes, study finds

After preliminary observations of 200 novel coronavirus (COVID-19) patients with severe hyperglycemia, researchers from Michigan Medicine found high blood sugar may trigger worse outcomes in people infected with the virus, according to a new study published in the journal Diabetes.

Rodica Pop-Busui, MD, PhD, senior author and vice chair of clinical research in the Department of Internal Medicine, said they suspect it's the low grade, inflammatory nature of diabetes and hyperglycemia that promote the virus' inflammatory surge, resulting in insulin resistance and severe hyperglycemia.

Specifically, these patients are at an increased risk for mechanical ventilation, kidney replacement therapy due to kidney failure and requiring medications known as vasopressors to stop dangerously low blood pressure or steroids to combat acute respiratory distress syndrome.

In response, the researchers developed a blood sugar management tool that may potentially reduce risk of secondary infections, kidney issues and intensive care stays in people with diabetes, prediabetes, or obesity who get COVID-19.

The researchers set out to find a way to monitor patients' diabetes without having to use more personal protective equipment (PPE) to visit the rooms all the time, to reduce the healthcare provider's exposure to the virus as much as possible. Although typically accurate, a continuous glucose monitor wouldn't be as helpful because a patient's low blood pressure and the use of blood pressure medications could falsely elevate blood sugar levels.

The new protocol called for insulin delivery every six hours, and at the same time a nurse would check in on the patient. Some patients who were on ventilators or receiving high doses of vitamin C would get their arterial or venous blood sugar levels checked, replacing the need for the team's blood sugar check, according to the study.

For those with the highest blood sugar levels and severe hyperglycemia, insulin infusions were an option for patients until their levels fell between a normal range. The result of these efforts helped successfully lower blood sugar levels without increasing nurse contact or the overall burden on primary care teams and PPE usage, the researchers said.

The researchers said this algorithm was not developed as a result of a clinical trial but is based solely on preliminary observations in the patients the team followed. A larger randomized controlled study is necessary to determine how this algorithm impacts mortality, time to recovery, the length of ICU stays and rate of severe complications, they said.  

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