Glytec, the only provider of insulin management software across the continuum of care, today announced the results of the first COVID-19 research to study the window of opportunity for treating hospitalized patients with hyperglycemia or diabetes. The peer-reviewed study, published in Diabetes Care, the journal of the American Diabetes Association, found a higher risk of mortality for patients that did not achieve target blood glucose levels soon after admission. This includes a sevenfold mortality risk for non-ICU patients with severe hyperglycemia after 48 to 72 hours.
“This research suggests that blood sugars should be high on the order set for COVID-19 patients, irrespective of a pre-existing diabetes diagnosis. We can control blood sugars in the hospital, but for a variety of reasons, this study shows that it’s not happening or hasn’t been a priority for COVID-19 patients,” said Guillermo E. Umpierrez, MD, chief of diabetes and endocrinology at Grady Memorial Hospital and co-author of the research. “Our findings strongly suggest that early intervention to bring blood glucose into a target range will reduce mortality rates in COVID-19 patients.”
Many studies have shown that target blood glucose levels can be consistently achieved within as little as six hours for ICU patients using intravenous insulin and within two days for non-ICU patients using standard subcutaneous basal-bolus insulin regimens. This study defined target blood glucose as 140-180 mg/dL, which the American Diabetes Association and the American Association of Clinical Endocrinologists recommend for a majority of hospitalized patients. In this COVID-19 study, however, more than half of patients in the ICU (56%) and non-ICU (53%) did not achieve target blood glucose levels within the first two or three days.
The study found that reaching a glucose value of 140 mg/dL or 141-180 mg/dL within two days after ICU admission or between two and three days in the non-ICU setting, respectively, is associated with reduced mortality. This is statically significant in the non-ICU setting and trending toward significance in the ICU population. The greater survival of individuals with better control after admission, compared with patients with uncontrolled glucose levels (greater than 250 mg/dL), is clinically meaningful and indicates the need to start treatment of hyperglycemia on admission.
“The high percentages of patients with COVID-19 presenting with hyperglycemia who did not reach a target blood glucose range represents a missed opportunity to improve clinical outcomes. More than half of the patients in our study could have benefitted from earlier and more aggressive treatment of hyperglycemia during their hospitalization,” said Jordan Messler, MD, executive director of clinical practice at Glytec and co-author of the research. “Our analysis suggests patients with COVID-19 should promptly receive treatment to improve glycemic control. The opportunity window is a very important aspect of care, especially when you consider the number of people living with undiagnosed diabetes and the fact that steroids – which contribute to hyperglycemia – are being widely used to treat COVID-19 patients.”
Dr. Messler stressed that while this research is important for establishing best practices for COVID-19 patient care, it’s not surprising given what is already known about the importance of glycemic management. “This result reinforces our knowledge that for many conditions like sepsis, coronary disease, pneumonia, stroke and the critically ill, hyperglycemia on admission is a marker for worse outcomes, and good glycemic management during the hospital stay leads to better outcomes,” Dr. Messler said.
The research was conducted using pooled data in the Glytec national database from patients in 91 hospitals across 12 states. The database included 9,959 patients with COVID-19 positive laboratory tests and blood sugar measurements from March 1 to May 8, 2020, when the analysis was conducted. After omitting patients, including those admitted for less than 24 hours, those under 18 years of age, and active admissions (those who had neither died nor been discharged), 1,601 patients were included in the final analysis. Only 12% of the study population used commercial glucose management software, and the study did not analyze this detail.
The full, peer-reviewed paper, “Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients with COVID-19: A Multicenter, Retrospective Hospital-Based Analysis,” is available online and will appear in the February issue of Diabetes Care. For additional information on important factors relating to insulin management and COVID-19, visit Glytec’s COVID-19 resource page.
About Diabetes Care®
Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention. Dedicated to increasing knowledge, stimulating research and promoting better health care for people with diabetes, the journal publishes original articles on human studies in clinical care, education and nutrition; epidemiology, health services and psychosocial research; emerging treatments and technologies; and pathophysiology and complications. Diabetes Care also publishes the ADA’s recommendations and statements, clinically relevant review articles, editorials and commentaries. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes care and education specialists and other health care professionals.
Glytec is the insulin management software company for healthcare providers focused on improving the quality and cost of care. Its FDA-cleared titration software and proprietary algorithms power the only solution capable of delivering personalized diabetes treatment recommendations across the continuum of care, from hospital to home. With ongoing support from its team of doctors, nurses and technologists headquartered outside of Boston, Glytec improves outcomes and controls costs for the large population of patients requiring insulin treatment – including those with and without a diagnosis of diabetes. For more information, follow Glytec on Twitter (@Glytec) or LinkedIn, or visit www.GlytecSystems.com.