(644) Association of Insulin Use and Glycemic Status With Dexamethasone Dose Patterns in COVID-19 Patients

Introduction: Corticosteroids have been widely used in the background of severe systemic inflammation with Coronavirus Disease 2019 (COVID-19). Our study aims to explore the association of glycemic status and insulin requirement with different dosing patterns of dexamethasone therapy among COVID-19 patients.

Methods: We performed a retrospective study on COVID-19 patients who were hospitalized across various Mayo Clinic sites between March 2020 to June 2022 and enrolled in the Society of Critical Care Medicine VIRUS COVID-19 registry (IRB 20-002610). We classified dexamethasone dosing as low dose (6 mg), intermediate dose (7-19mg), and high dose (20 mg). Patients were excluded if they were < 18 years old, did not receive dexamethasone, or received it at a dose >20mg or < 6mg. Data were collected by automated data pull.

Results: Out of 4188 patients in our study, the majority were males (60.1%), Caucasian (86.4%), and non-Hispanic (89.4%). 2937 (70.13%) patients received low-dose, 706 (16.86%) received intermediate-dose, and 545 (13.01%) received high-dose dexamethasone. The duration of steroid therapy was longer with higher doses (3.9 vs. 4.8 vs. 8.7 days, p< 0.001). Compared to the low-dose group, patients in the intermediate and high-dose groups were less likely to have hypertension (45.3% vs. 44.6% vs. 36.3%, p< 0.001) and chronic kidney disease (10.6% vs 10.6% vs 7.2%, p=0.039). The high-dose group had more patients with baseline WHO ordinal scale score ≥5 at admission (21.2% vs. 37.3% vs. 53.8%, p < 0.001).

Patients who received higher doses of steroids had a higher baseline random glucose level at admission (median 143 vs. 155 vs. 173 mg/dL, p< 0.001). The requirement for insulin therapy (41.5% vs. 50.3% vs. 67.7%, p< 0.001) during the hospitalization, as well as mean daily insulin requirement (22.8 vs. 18.0 vs. 30.6 IU, p < 0.001), was higher among the high-dose steroid group.
In a multivariate model adjusted for demographics, comorbidities, and baseline WHO ordinal scale score, with each 5 mg increase in the maximum dexamethasone dose, there was a 5.31 unit increase in mean daily insulin requirement.

Conclusions: In this retrospective study, COVID-19 patients with higher doses of dexamethasone had a higher insulin requirement, although no difference was noted in the mean daily glucose level.