Edinburgh, Scotland—The steroid dexamethasone is one of the very few drugs confirmed as a generally safe and effective treatment for COVID-19. A recent conference presentation cautions, however, that diabetes-like complications need to be carefully monitored during its use.

Research presented at the Society for Endocrinology annual conference in Edinburgh notes that by the second wave of the novel coronavirus pandemic, dexamethasone was routinely being used to treat hospitalized patients after data indicated it reduced ICU admissions and mortality.

The authors, from the UK’s Imperial College Healthcare NHS Trust, emphasize that the use of steroids increases blood sugar levels, which can be a serious health risk for patients diagnosed with diabetes. They add, however, that even with concerns about glucose levels, dexamethasone remains an inexpensive, life-saving, and effective treatment for COVID-19 as long as patients are monitored for any related complications.

Recognizing that an overactive immune system is an factor with COVID-19, the investigators of the RECOVERY group quickly mobilized clinical trials and verified that the use of an immunosuppressing steroid was beneficial in patients requiring oxygen support and that it reduced the risk of death. The continuing dilemma, however, was that dexamethasone can induce diabetes or worsen existing diabetes, and patients with diabetes already were at greater risk for severe COVID-19. Was the treatment unsafe for them and others?

“We really didn’t know how to manage it, we were learning as we went along,” explains lead investigator Victoria Salem, PhD. “The RECOVERY trial showed that if you had COVID severe enough to need hospital treatment with a ventilator, then there was almost a third reduction in deaths for patients given dexamethasone.”

The study team further assessed the benefits of dexamethasone in terms of diabetes outcomes as well as any other complications stemming from raised blood sugar. To do that, the researchers compared outcomes for more than 800 patients in wave 1, who received no dexamethasone, with those for more than 1,300 patients in wave 2,  who routinely received dexamethasone.

The study reports that mortality alone, without taking ICU admission into account, was markedly lower in wave 2 (wave 27.6%, wave 2 18.8%, 31.8% reduced risk of death, P <.01). Independently associated with the primary outcomes were male gender, hypertension, increased frailty, and lower estimated glomerular filtration rate. Although dexamethasone significantly reduced the risk of death/ICU admission by 56% in patients with diabetes, its use was associated with increased risk of glycemic complications (odds ratio = 22.5, 95% CI 13.98-36.67, P <.0001). “However, the risk of death/ICU admission was not increased in those with post-dexamethasone complications,” the researchers add.

In patients with diabetes, use of the steroid was associated with the need for extra medications to maintain blood sugar control, and in a few cases serious diabetic complications occurred.

“We were concerned that dexamethasone was a double-edged sword for patients with diabetes, and while we did see an increase in steroid-induced diabetes and worsened diabetes, deaths were significantly reduced in wave two for all patients,” Dr. Salem points out. “We now feel confident using dexamethasone for patients with diabetes in the future, just with the caveat that it may result in a short-term worsening of their condition. We need to make sure that we’ve got the right resource available to educate them and monitor them through that period.”

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