Association between SGLT2 inhibitor treatment and diabetic ketoacidosis and mortality in people with type 2 diabetes admitted to hospital with COVID-19

   Objective  To determine the association between prescription of SGLT2 inhibitors and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes hospitalized with COVID-19.  Research Design and Methods  This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centres in United Kingdom with data collection up to December 2020 that was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19.. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted and multivariable logistic regression models, were used to generate odds ratios and 95% confidence intervals for people prescribed SGLT2 inhibitor compared to those not prescribed SGLT2 inhibitor.   Results  The original national audit included 3067 people with type 2 diabetes who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2 inhibitors prior to hospital admission. Mean (SD) age of the overall cohort was 72 years, 62.3% were men and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% people died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2 inhibitors and those not (OR 0.56, 0.16-1.97). The adjusted odds of mortality associated with SGLT2 inhibitors were similar in the total study population (OR 1.13, 0.78-1.63 ), in the sub-group prescribed insulin (OR 1.02, 0.59-1.77), and in the sub-group that developed DKA (OR 0.21, 0.01-8.76).  Conclusions We demonstrate a low risk of DKA and high mortality rate in people with type 2 diabetes admitted to hospital with COVID-19 and limited power but no evidence of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2 inhibitors. </p

Interview schedule.

<p>Interview schedule.</p

Interviewee Characteristics.

<p>Interviewee Characteristics.</p

Interview Themes.

<p>Interview Themes.</p

Results of studies of physical activity and glycaemic control (HbA1c) in type 1 diabetes patients according to age groups of participants.

<p>Results of studies of physical activity and glycaemic control (HbA1c) in type 1 diabetes patients according to age groups of participants.</p

Does Exercise Improve Glycaemic Control in Type 1 Diabetes? A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>Whilst regular exercise is advocated for people with type 1 diabetes, the benefits of this therapy are poorly delineated. Our objective was to review the evidence for a glycaemic benefit of exercise in type 1 diabetes.</p> <p>Research Design and Methods</p><p>Electronic database searches were carried out in MEDLINE, Embase, Cochrane’s Controlled Trials Register and SPORTDiscus. In addition, we searched for as yet unpublished but completed trials. Glycaemic benefit was defined as an improvement in glycosylated haemoglobin (HbA1c). Both randomised and non-randomised controlled trials were included.</p> <p>Results</p><p>Thirteen studies were identified in the systematic review. Meta-analysis of twelve of these (including 452 patients) demonstrated an HbA1c reduction but this was not statistically significant (standardised mean difference (SMD) −0.25; 95% CI, −0.59 to 0.09).</p> <p>Conclusions</p><p>This meta-analysis does not reveal evidence for a glycaemic benefit of exercise as measured by HbA1c. Reasons for this finding could include increased calorie intake, insulin dose reductions around the time of exercise or lack of power. We also suggest that HbA1c may not be a sensitive indicator of glycaemic control, and that improvement in glycaemic variability may not be reflected in this measure. Exercise does however have other proven benefits in type 1 diabetes, and remains an important part of its management.</p> </div

Barriers, Facilitators and Motivators.

<p>Barriers, Facilitators and Motivators.</p

Metaregression by duration of study (A) and age of participants (B).

<p>Metaregression by duration of study (A) and age of participants (B).</p

Quality Assessment.

b<p>Although reported as a RCT, groups were randomly assigned by a diabetologist to either exercise programme. It is not clear if the controls were selected randomly or those who didn’t attend the exercise session were designated as controls.</p>c<p>randomisation occurred before consent was sought.</p

Study Characteristics and Results.

a<p>Participants performed one 2 hour supervised exercise session and an additional one 1 hour unsupervised session per week. Attendance for the unsupervised session was 52–89%.</p>b<p>Although reported as a RCT, groups were randomly assigned by a diabetologist to either exercise programme. It is not clear if the controls were selected randomly or those who didn’t attend the exercise session were designated as controls.</p>c<p>Control participants are the same for both interventions. These participants therefore appear twice in this table, explaining a total of 452 participants across all studies in this table.</p>d<p>Weighted mean (for two control groups).</p>e<p>Randomisation occurred before consent was sought.</p>f<p>Participants could undertake an additional unsupervised exercise session at home.</p>g<p>Median.</p