The excess insulin requirement in severe COVID-19 compared to non-COVID-19 viral pneumonitis is related to the severity of respiratory failure and pre-existing diabetes.

Lockhart, S.; Griffiths, H.; Petrisor, B.; Usman, A.; Calvo-Latorre, J.; Heales, L.; Bansiya, V.; Mahroof, R.; Conway Morris, A.

Abstract Objective Severe COVID-19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS-CoV-2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID-19 and non-COVID-19 viral pneumonitis. Research Design Retrospective cohort study of patients with severe COVID-19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non-COVID-19 viral pneumonitis patients was identified from routinely collected audit data. Results Insulin requirements were similar in patients with COVID-19 and non-COVID-19 viral pneumonitis after adjustment for pre-existing diabetes and severity of respiratory failure. Conclusions In this single center study, we could not find evidence of a unique diabetogenic effect of COVID-19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre-existing metabolic disease.