Guidance for the management of inpatient hyperglycemia in COVID-19

Diabetes and hyperglycemia are among the most common problems in hospitalized patients, a combination particularly evident in patients affected by COVID-19. Therefore the management of these, already complex, patients becomes critical. SARS-CoV2 infection increases insulin resistance and alters its production by pancreatic beta-cells, therefore severe hyperglycemia is frequent in patients admitted to COVID hospitals both already suffering from Diabetes mellitus or dysglycemia, and in those without known alterations of glucose metabolism. High-dose glucocorticoid treatment, frequently used in more complex COVID-19, also alters glucose metabolism, thus worsening hyperglycemia. Consequently, severe hyperglycemia is frequent, both in the admission phase and during hospitalization of COVID-19 in patients, and therefore, although the care and assistance of COVID-19 inpatients is complex, treatment of hyperglycemia cannot be underestimated. It has indeed been demonstrated that glucose levels above 180 mg/dL are known to be linked to increased mortality and worse prognosis of inpatients. In addition, people with diabetes are at a higher risk of serious COVID-19. The aim of this work was to offer to healthcare professionals involved in the care of COVID inpatients a support in making clinical decisions for the management of hyperglycemia, so to ensure both appropriate blood glucose surveillance and hyperglycemia management avoiding improper use of precious resources. Therefore, the Inpatient project group has developed easy-to-consult flow charts available on the AMD website during the COVID-19 pandemic second wave. KEY WORDS management of hyperglycemic crises; inpatients with COVID-19; glucocorticosteroid therapy.