采用地塞米松固定方案的 COVID-19 住院患者的胰岛素调整

COVID Pub Date : 2024-03-24 DOI:10.3390/covid4040029
Daliha Aqbal, Mariam Zakher, Sophie Nicolich-Henkin, Dajana Alku, Paula Choi, Neha Bansal, Shahidul Islam
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摘要

简介众所周知,COVID-19 与类固醇治疗结合使用会导致糖尿病患者出现高血糖。本研究的目的是为使用地塞米松治疗 COVID-19 的糖尿病患者制定新的胰岛素方案,以更好地控制血糖。研究设计与方法:这是一项回顾性队列研究,于 2020 年 7 月 1 日至 2021 年 7 月 1 日在纽约大学朗格尼长岛医院进行。符合条件的病例必须满足以下纳入标准:年龄在18岁或以上、有糖尿病史或新发糖尿病、诊断为COVID-19并接受10天地塞米松治疗、住院时间至少3天且至少接受48小时血糖监测、住院期间需要基础胰岛素和餐前胰岛素并进行校正。数据通过医院的电子记录系统收集。收集并评估血糖得到控制当天的基础胰岛素、餐前胰岛素和每日胰岛素的总剂量,如果出院时血糖仍未得到控制,则以地塞米松治疗结束日期为准。结果共分析了 145 例患者。约 46% 的患者实现了血糖控制。所需的胰岛素平均剂量为 0.67(0.61-0.74)单位/公斤。胰岛素的平均总剂量为 59 单位。基础胰岛素的平均总剂量为 21 单位。餐前胰岛素的平均总剂量为 38 单位。所有参与者的餐前平均剂量均高于基础剂量。结论使用地塞米松的 COVID-19 糖尿病患者应开始使用至少 0.6-0.7 u/kg 的胰岛素,以达到控制血糖的目的。
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Insulin Adjustments for Hospitalized COVID-19 Patients on a Fixed Dexamethasone Protocol
Introduction: COVID-19, in combination with steroid treatment, is known to propagate hyperglycemia in diabetic patients. The purpose of this study was to establish a new insulin protocol for diabetic patients with COVID-19 on the dexamethasone protocol for better glycemic control. Research Design and Methods: This was a retrospective cohort study conducted at NYU Langone Long Island Hospital from 1 July 2020 to 1 July 2021. Eligible cases had to meet the following inclusion criteria: age of 18 years or greater, history of or new-onset diabetes, diagnosis of COVID-19 and receiving the 10 day dexamethasone treatment, length of stay of at least 3 days with a minimum of 48 h of glucose monitoring, and requiring basal and prandial insulin with correction during hospital stay. Data were collected using the hospital’s electronic record system. The total basal, prandial, and daily doses of insulin on the day at which glycemic control was achieved, or if glycemic control was not achieved by the discharge date, then on the completion date of the dexamethasone treatment, were collected and assessed. Results: A total of 145 patient cases were analyzed. About 46% of patients achieved glycemic control. The average insulin dose required was 0.67 (0.61–0.74) unit/kg. The mean total dose of insulin was 59 units. The mean total basal dose was 21 units. The mean total prandial dose was 38 units. The average prandial doses were higher than the basal doses for all participants. Conclusions: Diabetic patients with COVID-19 on dexamethasone should be initiated on at least 0.6–0.7 u/kg of insulin to achieve glycemic control.
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