As of the end of January, 2021 there have been over 100 million documented COVID-19 cases worldwide, with over 2 million deaths attributed to COVID-19
As of the end of January, 2021 there have been over 26 million documented COVID-19 cases in the United States, with over 430,000 deaths attributed to COVID-19
Since the COVID-19 pandemic hit the U.S. in April 2020, there have been 30,000 to 120,000 COVID-19 patients hospitalized in the U.S. on a daily basis (see graph to the left)
In the U.S., the average mortality rate of patients admitted to the hospital with COVID related symptoms is around 15%
Critically ill COVID-19 patients who require admission to the ICU for more advanced care, such as mechanical ventilation, have mortality rates of around 40%
Age greater than 75, obesity, and diabetes and hypertension are all risk factors for increased mortality from COVID-19
This animal study looked at the effect of elevated glucose levels on an animal model of acute lung injury. The animals with higher glucose levels sustained worse lung injury. The animals treated with insulin had less lung injury
A laboratory study demonstrated increased uptake of COVID viral particles into white blood cells (monocytes), with increasing glucose levels. This same study also demonstrated increased cytokine production by the COVID infected monocytes, when glucose levels were increased. The measured increase was at least 10X greater than what was measured with lower glucose levels
An Italian study by Sardu demonstrated that when the blood glucose level was lowered through use of IV insulin, from the time of admission, that COVID mortality rates were significantly lowered. In this non-randomized study, patients admitted to the hospital with COVID were offered the choice of lowering their glucose levels with subcutaneous (SC) insulin injections or IV insulin. The patients who chose SC insulin had average hospital glucose levels of 192 mg/dL, versus 138 mg/dL in the patients treated with IV insulin. The patients treated with IV insulin had significant lowering of their cytokine response, abnormalities on chest CT, and mortalIty rates
A U.S. study by Bode on 570 COVID patients demonstrated that the group of patients (n= 184) with either diabetes or uncontrolled hyperglycemia (> 180 mg/dL) had a mortality rate of 28.8%, versus a mortality rate of 6.2% in the group of patients (n= 386) without diabetes or uncontrolled hyperglycemia. The average hospital glucose level of the diabetes/uncontrolled hyperglycemia group was 179 mg/dL, versus 117 mg/dL in the group without diabetes/uncontrolled hyperglycemia
A study by Matmani on 403 consecutively admitted COVID patients demonstrated that development of hyperglycemia during the first 48 hours of hospitalization increases the odds of dying by more than 300%. The group of patients who developed hyperglycemia had higher rates of ICU admission, development of severe pneumonia (ARDS), mechanical ventilation, and experienced a longer length of stay in the hospital. Overall, 57% of the patients in this study developed hyperglycemia
A study by Saand on 495 COVID patients admitted to the ICU setting demonstrated that patients with an average glucose level greater than 140 mg/dL experience a mortality rate of 31.4 %, versus 16.6 % in patients whose average blood glucose was less than 140 mg/dL. Patients with hyperglycemia also had a 35% increase in the need for mechanical ventilation, and spent 2 more days in the ICU.
This nationwide study from 109 hospitals in Spain demonstrated that the glucose level on admission was a good predictor of the patients mortality rate. The mortality rate was 15.7% when the admission glucose was less than 140 mg/dL, and increased to 41.1% when the admission glucose was greater than 180 mg/dL.
This Chinese study from 19 hospitals on 7,337 hospitalized COVID patients demonstrated that patients with type 2 diabetes had a 7.8% mortality rate versus 2.7% in those without type 2 diabetes. In a well matched subgroup of type 2 diabetes patients, they demonstrated that the group of patients (n = 250) with poorly controlled glucose levels (median glucose =191 mg/dL) had a mortality rate of 11.1%, versus 1.1% in the group (n =250) with well controlled glucose levels (median glucose = 115 mg/dL). These differences in the matched type 2 diabetes subgroup occurred despite the two groups having similar chest CT findings on admission. The graphic seen to the left is from this study - Zhu, Cell Metabolism, 2020
A meta-analysis of 16 observational COVID studies of 6,386 patients demonstrated that the group of patients with elevated glucose levels on admission had increased risk of death (OR = 3.45) and severe complications (OR = 2.08)
In this study performed on critically ill COVID patients, the majority of whom were receiving mechanical ventilation and/or vasopressor support, the Dexcom G6 CGM system had 98% of its values in the clinically relevant zones A & B on a Clarke error grid analysis. Glucose values in zones A and B are considered to be accurate enough to be used for insulin treatment decisions, with no adverse clinical outcomes expected from use of glucose values in zones A & B
In this small observational study, the Dexcom G6 CGM system was shown to have 100% of its values in zones A & B on a Clarke error grid analysis. The glucose mean absolute relative difference (MARD), which is a sensor error measurement, was less than 10% - this is an excellent result. In simulation studies of the FUSION systems AI based glucose control software, we achieved safe and effective glucose control when the glucose sensor error was set to 10%.