Kethireddy R, Gandhi D, Kichloo A, Patel L. Challenges in hyperglycemia management in critically ill patients with COVID-19. World J Crit Care Med 2022; 11(4): 219-227 [PMID: 36051939 DOI: 10.5492/wjccm.v11.i4.219]
Corresponding Author of This Article
Darshan Gandhi, MD Assistant Professor, Department of Diagnostic Radiology, University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN 38103, United States. darshangandhi7@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jul 9, 2022; 11(4): 219-227 Published online Jul 9, 2022. doi: 10.5492/wjccm.v11.i4.219
Challenges in hyperglycemia management in critically ill patients with COVID-19
Rajesh Kethireddy, Darshan Gandhi, Asim Kichloo, Love Patel
Rajesh Kethireddy, Love Patel, Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
Darshan Gandhi, Department of Diagnostic Radiology, University of Tennessee Health Science Center, Memphis, TN 38103, United States
Asim Kichloo, Internal Medicine, Central Michigan University School of Medicine, Mt Pleasant, MI 48859, United States
Author contributions: Kethireddy R conceived the idea of this article and contributed to the writing and revision of the manuscript substantially; Gandhi D contributed to the discussion and revision of the manuscript substantially; Kichloo A contributed to the manuscript format and editing of the manuscript substantially; Patel L contributed to the manuscript formation and reference numbering of the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing or conflicts of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Darshan Gandhi, MD Assistant Professor, Department of Diagnostic Radiology, University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN 38103, United States. darshangandhi7@gmail.com
Received: April 2, 2021 Peer-review started: April 2, 2021 First decision: July 31, 2021 Revised: August 10, 2021 Accepted: May 8, 2022 Article in press: May 8, 2022 Published online: July 9, 2022 Processing time: 460 Days and 12.4 Hours
Abstract
Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality. The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance, critical illness hyperglycemia (stress- induced hyperglycemia) secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action, acute cytokine storm and pancreatic cell dysfunction. Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of hyperglycemia in COVID-19 is often complicated by use of steroids, prolonged total parenteral or enteral nutrition, frequent acute hyperglycemic events, and restrictions with fluid management due to acute respiratory distress syndrome. While managing hyperglycemia special attention should be paid to mode of insulin delivery, frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment. In this article we describe the pathophysiology of hyperglycemia, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.
Core Tip: Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes are more likely to experience hyperglycemia related complications including diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. These patients often require hospitalization to intensive care units. In this article we intend to describe the pathophysiology of hyperglycemia in critically ill patients with COVID-19 infection, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.
