Endocrine Abstracts

Introduction: Previous studies have reported that SARS-CoV-2 infection is associated with a more severe disease and worse outcome in patients with diabetes mellitus. Insulin is the mainstay of diabetes therapy in the inpatient setting. However, the treatment of diabetes in patients with COVID-19 remains unclear. In this study we investigate the influence of different insulin regimens and other antidiabetic medications on glucose control and mortality in COVID-19 patients with type 2 diabetes.

Methods: We conducted a retrospective electronic medical record analysis of 359 type 2 diabetes patients hospitalized with COVID-19 between 01/04/2020 and 31/03/2021 in the Emek Medical Center. The following baseline characteristics included in the study are: gender, age, BMI, GFR, CRP, preadmission diabetes treatment regimens, and comorbidities. We divided the patients into two groups based on their diabetes treatment during hospitalization. The first group included patients treated only with insulin, and the second group of patients were treated with insulin and other classes of antidiabetic drugs. We recorded data of patients’ 28-day mortality rates, preadmission diabetes treatment, average blood glucose, diabetes treatment regimens at discharge, and HbA1C levels 6 months before and after hospitalization in both groups.

Results: Of 359 patients, 82 were mechanically ventilated and 110 patients suffered a severe course of COVID-19. The mortality rate on day 28 after admission was similar in patients treated with insulin only and those treated with a combination of insulin and other treatment modalities (P=0.29) and remains non-significant after exclusion of mechanically ventilated patients from the statistical analysis. Patients who survived their hospital stay had lower CRP levels at admission (11.5±8.2 vs 16.1±9.7;P=0.000). During hospitalization, most of the patients in the combination therapy group received metformin on top of insulin (131 out of 162, 80%), 28 patients (17%) received SGLT-2 inhibitors, 12 (7%) were treated with DPP-IV or GLP-1 agonists, and seven patients (4%) with sulfonylureas. Regarding diabetes control, HbA1C levels improved after hospitalization in both groups of treatment, and overall: A1C levels before admission were 7.9±1.9 mg% and after 7.5±1.7 mg% (P=0.002).

Conclusion: Basal bolus insulin regimens, as well as a combination of insulin and other classes of antidiabetic medications, were not associated with dissimilar mortality rates in patients affected with SARS-CoV-2. Our study shows that new antidiabetic medications, such as incretin-based therapy and SGLT-2i, as well as metformin in combination with insulin may safe, and effectively control glucose levels in hospitalized COVID-19 patients.