Insulin Treatment Is Associated with Increased Mortality in Patients with COVID-19 and Type 2 Diabetes

TVNET3 April 5, 2022 3:27 pm

Bo Yu¹, Chenze Li², Yang Sun¹, Dao Wen Wang³

Affiliations

PMID: 33248471
PMCID: PMC7682421
DOI: 10.1016/j.cmet.2020.11.014

Free PMC article

Abstract

COVID-19 caused by SARS-COV-2 infection can lead to multi-organ injuries and significant mortality in severe and critical patients, especially among those individuals with type 2 diabetes (T2D) as a comorbidity. While attenuated mortality was observed with aggressive glucose control, it was unclear whether therapeutic regimens including insulin treatment were beneficial for patients with COVID-19 and T2D. This retrospective study investigated 689 patients with COVID-19 and T2D from a cohort of 3,305 cases from Wuhan, China. Unexpectedly, we found that insulin treatment for patients with COVID-19 and T2D was associated with a significant increase in mortality (27.2% versus 3.5%; adjusted HR, 5.38 [2.75-10.54]). Further analysis showed that insulin treatment was associated with enhanced systemic inflammation and aggravated injuries of vital organs. Therefore, insulin treatment for patients with COVID-19 and T2D should be used with caution.

Keywords: COVID-19; antidiabetic treatment; glycemic control; inflammation; insulin; mortality; type 2 diabetes.

Conflict of interest statement

Declaration of Interests The authors have declared that no competing interests exist.

Figures

Cited by 38 articles

Clinical Significance of COVID-19 and Diabetes: In the Pandemic Situation of SARS-CoV-2 Variants including Omicron (B.1.1.529).

Yonekawa A, Shimono N.Biology (Basel). 2022 Mar 4;11(3):400. doi: 10.3390/biology11030400.PMID: 35336774 Free PMC article. Review.
Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy.

Liu A, Raja Xavier J, Singh Y, Brucker SY, Salker MS.Front Glob Womens Health. 2022 Feb 24;3:756362. doi: 10.3389/fgwh.2022.756362. eCollection 2022.PMID: 35284910 Free PMC article. Review.
Glucose dysregulation and its association with COVID-19 mortality and hospital length of stay.

Mirabella S, Gomez-Paz S, Lam E, Gonzalez-Mosquera L, Fogel J, Rubinstein S.Diabetes Metab Syndr. 2022 Mar;16(3):102439. doi: 10.1016/j.dsx.2022.102439. Epub 2022 Feb 24.PMID: 35255293 Free PMC article.
Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection.

Guardado-Mendoza R, Garcia-Magaña MA, Martínez-Navarro LJ, Macías-Cervantes HE, Aguilar-Guerrero R, Suárez-Pérez EL, Aguilar-García A.Sci Rep. 2022 Jan 11;12(1):536. doi: 10.1038/s41598-021-04511-1.PMID: 35017617 Free PMC article. Clinical Trial.
Hyperglycemia and insulin resistance in COVID-19 versus non-COVID critical illness: Are they really different?

Langouche L, Van den Berghe G, Gunst J.Crit Care. 2021 Dec 17;25(1):437. doi: 10.1186/s13054-021-03861-6.PMID: 34920750 Free PMC article. No abstract available.

See all “Cited by” articles

References

1. Badawi A., Ryoo S.G. Prevalence of diabetes in the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus: a systematic review and meta-analysis. J. Public Health Res. 2016;5:733. – PMC – PubMed
1. Bode B., Garrett V., Messler J., McFarland R., Crowe J., Booth R., Klonoff D.C. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J. Diabetes Sci. Technol. 2020;14:813–821. – PMC – PubMed
1. Bornstein S.R., Rubino F., Khunti K., Mingrone G., Hopkins D., Birkenfeld A.L., Boehm B., Amiel S., Holt R.I., Skyler J.S. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546–550. – PMC – PubMed
1. Bramante C., Ingraham N., Murray T., Marmor S., Hoversten S., Gronski J., McNeil C., Feng R., Guzman G., Abdelwahab N. Observational study of metformin and risk of mortality in patients hospitalized with Covid-19. medRxiv. 2020 doi: 10.1101/2020.06.19.20135095. – DOI
1. Brundage S.I., Kirilcuk N.N., Lam J.C., Spain D.A., Zautke N.A. Insulin increases the release of proinflammatory mediators. J. Trauma. 2008;65:367–372. – PubMed