Managing blood sugar in dexamethasone-treated COVID-19 patients: UK Guidance
UK: The UK National Diabetes COVID-19 Response Group has released new guidance on dexamethasone therapy in COVID‐19 patients. The guidance addresses the management of blood sugar levels in COVID-19 patients who are taking dexamethasone therapy.
The guidance was developed in response to The RECOVERY trial that found that dexamethasone can prevent be death in around 8 ventilated patients and about one in 25 patients who require oxygen. This has been considered as an important regimen in spite of the fact that the study is yet to attain peer-review publication. Low dose dexamethasone therapy as described in this study (6 mg daily for 10 daily) in effect is five to six-fold greater than the therapeutic glucocorticoid replacement dose. High doses of glucocorticoids can worsen hyperglycemia in diabetes patients, may unmask undiagnosed diabetes and, in those at risk of diabetes, may precipitate hyperglycemia and new-onset diabetes. Glucocorticoids are the commonest cause of diabetes people developing potentially life-threatening hyperglycaemic hyperosmolar state (HHS) in the hospital.
To prevent the harms, described above Joint British Diabetes Societies (JBDS) published guidelines that address inpatient management of steroid-induced hyperglycemia. However, these guidelines may not be appropriate for patients with severe COVID-19 infection receiving dexamethasone, given dexamethasone-induced impaired glucose metabolism, COVID-19 impaired insulin production, and COVID-19-induced insulin resistance.
"Dexamethasone therapy in COVID‐19 patients: implications and guidance for the management of blood glucose in people with and without diabetes," is published in the journal Diabetic Medicine.
DOI: https://doi.org/10.1111/dme.14378
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