With the advent of the worldwide SARS-CoV-2 pandemic, clinicians and researchers scrambled to find effective therapies for the life threatening complications of COVID-19. Early clinical experience suggested that administering powerful steroids improves outcomes in people with COVID-19 who require oxygen or mechanical ventilation.
However, steroids have adverse side effects, including elevated blood glucose levels. In individuals with and without a history of diabetes, this can result in short- and long-term complications, such as an increased risk of infection or metabolic imbalance.
Researchers released results at the November 2021 Society for Endocrinology meeting after observing a large group of people with COVID-19 receiving treatment with dexamethasone, a steroid that doctors use to treat patients with lung inflammation.
Dr. Victoria Salem, a principal investigator, shared with Medical News Today: Dexamethasone is now standard of care in patients hospitalized with [COVID-19] requiring oxygen based on the RECOVERY trial. We looked at over 2,000 patients hospitalized with [COVID-19] in our London hospital and performed a multivariate analysis of risk factors for death.
Its already known that diabetes is a risk factor for severe COVID. High blood sugars are also a predictor of poor outcomes. Since dexamethasone pushes up blood sugars, we were worried that dexamethasone might have been a double-edged sword for patients with diabetes, but, in fact, it turned out to be just as effective.
To understand dexamethasones effects, researchers looked at the number of ICU admissions, reduced mortality, and steroid-related complications in 2,261 patients admitted to the Imperial College Healthcare National Health Service (NHS) Trust hospitals.
The team divided data from individuals hospitalized with COVID-19 into two groups: wave one and wave two. Wave one consisted of 889 people admitted to the hospital between March and April 2020, when doctors did not routinely prescribe dexamethasone. Wave two comprised 1,372 individuals admitted between November 2020 and January 2021 who took prescription dexamethasone routinely.
The study found that people were less likely to be admitted to the ICU in wave two (18.8%) compared to 27.6% in wave one. There was also a reduction in mortality in wave two, with a 31.8% reduced risk of death. Additional risk factors for ICU admittance and reduced mortality included having high blood pressure, increased frailty, reduced kidney function, and being male.
For Medical News Today, Dr. Salem elaborated:
In wave two, [d]examethasone was used in 68% of patients in our hospital with a diagnosis of [COVID-19], 35% of whom had diabetes.
[O]f the patients treated with dexamethasone for COVID, 19% developed hyperglycemia (high blood sugars) that required additional treatment. [A]nd, of this group, 12% were new diagnoses of diabetes the [r]emainder of patients experienced worsening preexisting diabetes.
[D]r. Salem clarified that this real world figure is much higher than the result that the original RECOVERY study reported.
So, 21 people out of 935 (2%) given dexamethasone for [COVID-19] developed steroid-induced diabetes.
Dexamethasone treatment reduced the risk of death or ICU admission in study participants by 56%. Dr. Salem explained to Medical News Today:
Dexamethasone was independently associated with a decreased risk of death/ICU admission to the same extent in people with [d]iabetes and those without diabetes.
Dexamethasone-induced diabetes often resolves when the treatment is stopped. It adds an extra burden in terms of management and follow-up but [is] worth it given the overall benefits in terms of recovering from [COVID-19]. Given the current obesity epidemic, many of the patients may already have had undiagnosed type 2 diabetes, and this was a wake-up call.
The studys take-home message is that dexamethasone treatment reduced the risk of death and ICU admission. Additionally, patients with diabetes are more likely to develop steroid-induced glucose control complications, but this did not increase death rates.
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Treating severe COVID-19: Study assesses risks of dexamethasone - Medical News Today
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