The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

  1. Sam M. Lockhart
  2. Harry Griffiths
  3. Bogdan Petrisor
  4. Ammara Usman
  5. Julia Calvo‐Latorre
  6. Laura Heales
  7. Vishakha Bansiya
  8. Razeen Mahroof
  9. Andrew Conway Morris

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Abstract

Introduction

Severe COVID‐19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS‐CoV‐2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID‐19 and non‐COVID‐19 viral pneumonitis.

Methods

This is a retrospective cohort study of patients with severe COVID‐19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non‐COVID‐19 viral pneumonitis patients was identified from routinely collected audit data.

Results

Insulin requirements were similar in patients with COVID‐19 and non‐COVID‐19 viral pneumonitis after adjustment for pre‐existing diabetes and severity of respiratory failure.

Conclusions

In this single‐centre study, we could not find evidence of a unique diabetogenic effect of COVID‐19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre‐existing metabolic disease.

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    SciScore for 10.1101/2020.10.03.20206284: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethical review statement: As a retrospective analysis of anonymized, routinely collected data the requirement for ethical committee review and consent was waived by the National Health Service Health Research Authority, the evaluation was registered with the responsible healthcare organization (Cambridge University Hospitals NHS Foundation Trust).
    Consent: Ethical review statement: As a retrospective analysis of anonymized, routinely collected data the requirement for ethical committee review and consent was waived by the National Health Service Health Research Authority, the evaluation was registered with the responsible healthcare organization (Cambridge University Hospitals NHS Foundation Trust).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  2. Version published to 10.1002/edm2.228
  3. Version published to 10.1101/2020.10.03.20206284v1 on medRxiv