Dexamethasone-induced Hyperglycaemia in COVID-19: Glycaemic Profile in Patients Without Diabetes and Factors Associated with Hyperglycaemia.

Aims: To evaluate glycaemic profiles of COVID-19 patients without diabetes receiving dexamethasone and determine factors associated with hyperglycaemia. Methods: All subjects without pre-existing diabetes receiving dexamethasone 6 mg for COVID-19 in a non-critical care setting were identified. Glucose profiles were obtained from capillary blood glucose (BG). Univariate and multivariate analyses were performed to identify factors associated with dexamethasone-induced hyperglycaemia (BG >= 10 mmol/L). Results: Of 254 subjects, 129 (50.8%) were male with age 51.1 +/- 18.2 years and weight 89.7 +/- 26.3 kg. Hyperglycaemia post-dexamethasone occurred in 121 (47.6%). Glucose excursions began within three hours (6.8 +/- 1.4 mmol/L pre-dexamethasone vs 8.7 +/- 2.4 mmol/L at <= 3 h, p < 0.001) and peaked at 7-9 h (10.5 +/- 2.3 mmol/L, p < 0.001 vs pre-dexamethasone). BGs post-intravenous were higher than post-oral administration for the initial six hours. Hyperglycaemic subjects were older (57.8 +/- 17.5 years vs 45.0 +/- 16.6 years, p < 0.001), had higher initial glucose (6.3 +/- 1.0 vs 5.9 +/- 0.9 mmol/L, p = 0.004), higher HbA1c (5.8 +/- 0.3% [40 +/- 3.5 mmol/mol] vs 5.5 +/- 0.4% [37 +/- 4.1 mmol/mol], p < 0.001) higher C-reactive protein (CRP) (100 +/- 68 vs 83 +/- 58 mg/L, p = 0.026), and lower eGFR (79 +/- 17 vs 84 +/- 16 mL/min/1.73 m(2), p = 0.045). Mortality was greater in the hyperglycaemia group (9/121 [7.4%] vs 2/133 [1.5%], p = 0.02). Age, HbA1c and CRP were independently associated with hyperglycaemia. Conclusions: Half of subjects without diabetes experienced hyperglycaemia post-dexamethasone for COVID-19, peak occurring after 7-9 h. Age, HbA1c and CRP were associated with hyperglycaemia.