Continuous glucose monitoring profile in COVID-19 patients with and without diabetes receiving methylprednisolone

Purpose Methylprednisolone is widely used during the COVID-19 epidemic. We aimed to evaluate the glucose profile of COVID-19 patients with and without diabetes receiving methylprednisolone. Methods 36 patients with COVID-19 admitted to hospital were included: 17 with and 19 without diabetes. Methylprednisolone 40 mg was administered at about 9:00 a.m. Glucose levels were assessed by blinded intermittently scanned continuous glucose monitoring (isCGM) for an average of 6.8 +/- 2.4 days. Excess hyperglycemia was defined as time above range (TAR) > 10.0 mmol/L (TAR(>10.0)) >= 25%, or TAR > 13.9 mmol/L (TAR(>13.9)) >= 10%. Results Glucose management indicator (GMI) was significantly higher than the admission glycated hemoglobin A(1c) (HbA(1c)) level in patients without diabetes [6.7 (6.1-7.0) % vs. 5.9 (5.9-6.1) %, P < 0.001], while no significant difference was found in patients with diabetes [9.0 (7.5-9.5) % vs. 8.9 (7.5-10.2) %, P > 0.05]. The difference between GMI and HbA(1c) (triangle GMI-HbA(1c)) in patients without diabetes was significantly higher than in patients with diabetes [0.7 (0.2-1.0) % vs. -0.2 (-1.5-0.5) %, P = 0.005]. The circadian patterns of glucose were similar in the two groups. In patients without diabetes, excess hyperglycemia occurred in 31.6% (6/19) of participants, with 31.6% (6/19) having a TAR(>10.0) >= 25%, while 21.1% (4/19) had a TAR(>13.9) >= 10%. Conclusion The impact of methylprednisolone on glycemia was more pronounced in COVID-19 patients without diabetes, compared to those with diabetes. A significant burden of methylprednisolone-induced hyperglycemia was observed in patients without diabetes.