(984) Glucose Control in ICU Patients During the COVID Pandemic

Introduction: Coronavirus Disease-19 (COVID) intensive care unit (ICU) patients have variable glycemic control due to critical illness combined with potential direct effects of the virus on pancreatic function. Severe COVID often leads to a systemic inflammatory response comparable to sepsis. A study from the first wave of the COVID pandemic found that patients with COVID had poor glycemic control, but this may have been limited by stabilization of resources and clinical practice. The aim of this study was to compare glycemic control for critically ill COVID-positive patients versus a COVID-negative control group treated for presumed sepsis in the medical ICU.

Methods: This was a single-center, retrospective cohort study, conducted from December 1, 2020, to December 31, 2022. Adult medical ICU service patients admitted for >48 hours and receiving at least 24 hours of insulin therapy were included. Patients that were pregnant, treated for diabetic ketoacidosis, or treated with high-dose insulin for overdose were excluded. The primary outcome was time in goal blood glucose (BG) range 70-179 mg/dL. Secondary efficacy outcomes included percent of hyperglycemic readings, time to goal BG range, BG variability, mean BG readings, and insulin requirements. Secondary adverse event outcomes included incidence of hypoglycemia. Length of stay and mortality were defined as secondary clinical outcomes.

Results: 100 patients were included (n = 50 COVID, n = 50 control). Time within goal BG range was lower in the COVID group (27.5% vs. 50%, p < 0.001). Mean BG over the first 5 days and percent of hyperglycemic readings were higher in the COVID group. Time to BG goal was longer in the COVID group (2 days vs. 0.5 days, p < 0.001). Mean BG variability was higher in the COVID group (57 vs. 44 mg/dL, p = 0.025). Average daily insulin requirements were higher in the COVID group (42 vs. 33 units, p = 0.017). There were no differences between groups in hypoglycemic events, length of stay or mortality outcomes.

Conclusions: Compared to non-COVID ICU patients treated empirically for sepsis, COVID ICU patients consistently had more resistant hyperglycemia despite higher insulin dosing throughout the pandemic. Variable glycemic control in COVID patients did not directly impact the measured clinical outcomes.