Could Exogenous Insulin Ameliorate the Metabolic Dysfunction Induced by Glucocorticoids and COVID-19?

Abstract

The finding that high-dose dexamethasone improves survival in those requiring critical care due to COVID-19 will mean much greater usage of glucocorticoids in the subsequent waves of coronavirus infection. Furthermore, the consistent finding of adverse outcomes from COVID-19 in individuals with obesity, hypertension and diabetes has focussed attention on the metabolic dysfunction that may arise with critical illness. The SARS coronavirus itself may promote relative insulin deficiency, ketogenesis and hyperglycaemia in susceptible individuals. In conjunction with prolonged critical care, these components will promote a catabolic state. Insulin infusion is the mainstay of therapy for treatment of hyperglycaemia in acute illness but what is the effect of insulin on the admixture of glucocorticoids and COVID-19? This article reviews the evidence for the effect of insulin on clinical outcomes and intermediary metabolism in critical illness.

• Authors: Martin Brunel Whyte, Prashanth R J Vas, Anne M Umpleby
• Journal: Frontiers in endocrinology (Front Endocrinol (Lausanne)) 2021 Vol. 12 Pg. 649405 ISSN: 1664-2392 [Print] Switzerland
• PMID: 34220705 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2021 Whyte, Vas and Umpleby.

Chemical References

• Glucocorticoids
• Insulin
• Dexamethasone

Topics

• COVID-19 (complications)
• Critical Care (methods)
• Critical Illness (therapy)
• Dexamethasone (adverse effects, therapeutic use)
• Diabetes Complications (diagnosis, drug therapy, mortality)
• Diabetes Mellitus (drug therapy, mortality, virology)
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Hyperglycemia (complications, drug therapy, mortality)
• Insulin (therapeutic use)
• Metabolic Diseases (chemically induced, etiology, prevention & control)
• Obesity (complications, drug therapy, mortality)
• SARS-CoV-2 (physiology)
• Treatment Outcome
• COVID-19 Drug Treatment