Covid-19, Dexamethasone and Diabetes(CODED) study: a single centre experience

Noha Meneissy; Scott Waring; Umme Farhana; Sarah Kasigwa; Yishan Wang; Tasfia Rashid; Sohee Kim; Shanta Paul; Htet Myat Hlaing; Sukuta Darego; Sadia Siddika; Olga Nachas; Lamis Fahal; Bashir Mahamud; Gideon Mlawa

doi:10.1530/endoabs.81.P577

Coronavirus (COVID-19) caused by severe acute respiratory syndrome (SARS)-CoV-2, which leads to multi-organ disease. Covid-19 high mortality and morbidity arising from autoimmune destruction of the lungs due to pro-inflammatory cytokines storm, has enabled worldwide collaborative studies aimed at elucidating potential management strategies in order to overcome pandemic. The RECOVERY trial, a multi-centred trial involving 175 United Kingdom based hospitals. The results from this trial revealed that using dexamethasone lowered 28-day mortality rate for patients receiving either invasive mechanical ventilation or oxygen but had no effect on patients not receiving respiratory support. Using dexamethasone can cause manifestation of hyperglycaemia or induce Diabetes mellitus in previously non-diabetic patients. In the present study, we looked at 100 patients (both diabetics and non-diabetics) with COVID 19 on dexamethasone and we monitored their glucose levels.

Aims: 1. To assess doctors’ and nurses’ knowledge of dexamethasone related hyperglycaemia and diabetes.

2. To assess doctors’ awareness of guidelines for management of patients with COVID-19 who started on dexamethasone and whether they were using it.

3. To assess if patients who had hyperglycaemia and/or hyperglycaemia related complications were seen by diabetes team when appropriate

4. To improve doctors and nurses’ awareness of proper management of patients with COVID-19 who need to be started on dexamethasone

Methods: Retrospective analysis of paper notes, case notes & electronic records of patient reported outcome (EPRO). Single centre study 100 randomly selected patients with RT-PCR COVID-19 treated with dexamethasone admitted to Queens hospital.

Results: 100 COVID-19 positive given dexamethasone treatment. 18 patients were known T2DM, 82 were non-diabetic. Of the 100 patients, only 87 had regular glucose monitoring, 67 had monitoring as per BHRUT guidelines. Out of the monitored patients (87) 30 patients had hyperglycaemia which was more frequent in T2DM patients (9; 50%). Of those who developed hyperglycaemia 11 (37%) patients had their hyperglycaemic episodes treated as per national guidelines and 10 diabetic patients (56%) with T2DM required up titration of their medications. One of non-diabetic patients started on insulin.

Discussion/conclusion: Dexamethasone can be associated with hyperglycaemia in non-diabetic and known diabetic mellitus increasing their mortality and morbidity risk. Thus, it is important that these patients be monitored and managed according to national and local guidelines. Therefore, we intend to create new proformas to keep doctors and nurses up to date with the guideline of management of COVID 19 patients on dexamethasone.

Endocrine Abstracts

P577