Francisco J. Pasquel, M.D., from the Emory University School of Medicine in Atlanta, and colleagues used individual-level inpatient data from 175 U.S. hospitals (17 states; Feb. 1 to Sept. 15, 2020) to examine severity markers of DKA, insulin requirements, complications, and in-hospital case fatality in 5,029 patients treated with the same computerized continuous insulin infusion (CII) algorithm with and without COVID-19.

The researchers found that 4 percent of patients (210 patients) were positive for COVID-19. Those with COVID-19 were older and had a higher body mass index compared with patients without COVID-19. Older patients with COVID-19 (>65 years) were more likely to have cardiovascular disease and diabetes complications than younger patients with COVID-19 (<45 years). Higher insulin requirements and a prolonged duration of CII with a longer time to resolution of DKA were seen among patients with COVID-19. Five percent of patients without COVID-19 died in the hospital versus 30 percent among those with COVID-19. Acute kidney injury was more frequent in patients with COVID-19 versus those without (30 versus 10 percent).

"These findings are worrisome and warrant further investigation," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry, and several reported working at an insulin management software company.

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