STUDI PENGGUNAAN DEKSAMETASON PADA PASIEN COVID-19 DERAJAT BERAT DENGAN KOMORBID DIABETES MELLITUS
Abstract
Administration of Dexamethasone in patients with diabetes needs attention because corticosteroids can increase blood glucose concentrations. Therefore, this study aims to determine the effectiveness of using Dexamethasone in patients with severe COVID-19 and how to regulate blood glucose in patients with severe COVID-19 in patients with comorbid Diabetes Mellitus. Inclusion criteria for severe COVID-19 patients with comorbid Diabetes Mellitus who use Dexamethasone and therapy groups and receive insulin therapy with or without OAD in inpatient installations. The sample data obtained from the patient's medical records were 27 patients who met the inclusion and exclusion criteria consisting of 70% male and 30% female. Dexamethasone dose of 1 x 6 mg iv mostly uses combination therapy A, the duration of administration is 8 days, and has an average length of stay of 13 days. The shortest average length of hospitalization was 12 days for patients receiving dexamethasone with therapy C for 10 days, while therapy B for 5 days had an average hospitalization of 14 days. Administration of Dexamethasone dose of 1 x 6 mg iv is effective in severe COVID-19 patients with comorbid Diabetes Mellitus based on the length of hospitalization, respectively 13 days, 14 days, and 12 days with an improvement in the clinical condition of oxygen saturation by 91%, 100%, 100%; RT-PCR/Rapid Ag became negative 74%, 100%, 100%; improvement of chest x-ray results, namely 83%, 33%, 100%. The effect of glucocorticoid dexamethasone in comorbid Diabetes Mellitus patients is regulated by administering long-acting insulin, rapid-acting insulin, and oral anti-diabetic.
Downloads
References
Al-Samkari, H., Karp Leaf, R. S., Dzik, W. H., Carlson, J. C. T., Fogerty, A. E., Waheed, A., Goodarzi, K., Bendapudi, P. K., Bornikova, L., Gupta, S., Leaf, D. E., Kuter, D. J., & Rosovsky, R. P. (2020). COVID-19 and coagulation: Bleeding and thrombotic manifestations of SARS-CoV-2 infection. In Blood (Vol. 136, Issue 4). https://doi.org/10.1182/BLOOD.2020006520
Alessi, J., De Oliveira, G. B., Schaan, B. D., & Telo, G. H. (2020). Dexamethasone in the era of COVID-19: Friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes. Diabetology and Metabolic Syndrome, 12(1), 1–11. https://doi.org/10.1186/s13098-020-00583-7
American Diabetes Association. (2021a). Diabetes care in the hospital: Standards of medical care in diabetes-2021. Diabetes Care, 44(January), S211–S220. https://doi.org/10.2337/dc21-s015
American Diabetes Association. (2021b). Glycemic targets: Standards of medical care in diabetes. Diabetes Care, 44(January), S73–S84. https://doi.org/10.2337/dc21-S006
American Diabetes Association. (2021c). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetesd2021. Diabetes Care, 44(January), S111–S124. https://doi.org/10.2337/dc21-S009
Annane, D. (2021). Corticosteroids for COVID-19. Journal of Intensive Medicine, 1(1), 14–25. https://doi.org/10.1016/j.jointm.2021.01.002
Cai, H. (2020). Sex difference and smoking predisposition in patients with COVID-19. The Lancet Respiratory Medicine, 8(4), e20. https://doi.org/10.1016/S2213-2600(20)30117-X
Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, Liu X, Chen R, Guan, W. J., Liang, W. H., Zhao, Y., Liang, H. R., Chen, Z. Z. S., Li, Y. M., Liu, X. Q., Chen, R. C., Tang, C. L., Wang, T., Ou, C. Q., … Chen R. (2020). Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. The European respiratory journal [revista en Internet] 2020 [acceso 11 de mayo de 2020]; 1-56. In The European respiratory journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098485/
Huang, I., Lim, M. A., & Pranata, R. (2020). Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression: Diabetes and COVID-19. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14(4), 395–403. https://doi.org/10.1016/j.dsx.2020.04.018
Kang, S. J., & Jung, S. I. (2020). Age-Related Morbidity and Mortality among Patients with COVID-19. Infection and Chemotherapy, 52(2), 154–164. https://doi.org/10.3947/ic.2020.52.2.154
Kemenkes RI. (2020). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MenKes/413/2020 Tentang Pedoman Pencegahan dan Pengendalian Corona Virus Disease 2019 (Covid-19). MenKes/413/2020, 2019, 207.
Miesbach, W., & Makris, M. (2020). COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clinical and Applied Thrombosis/Hemostasis, 26. https://doi.org/10.1177/1076029620938149
Murphy, G. S., Szokol, J. W., Avram, M. J., Greenberg, S. B., Shear, T., Vender, J. S., Gray, J., & Landry, E. (2014). The effect of single low-dose dexamethasone on blood glucose concentrations in the perioperative period: A randomized, placebo-controlled investigation in gynecologic surgical patients. Anesthesia and Analgesia, 118(6), 1204–1212. https://doi.org/10.1213/ANE.0b013e3182a53981
PDPI, PERKI, PAPDI, PERDATIN, & IDAI. (2020). Pedoman tatalaksana COVID-19 Edisi 3 Desember 2020. In Pedoman Tatalaksana COVID-19. https://www.papdi.or.id/download/983-pedoman-tatalaksana-covid-19-edisi-3-desember-2020
PERKENI. (2019). Pengelolaan Dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia. In Perkeni.
Seiglie, J., Platt, J., Cromer, S. J., Bunda, B., Foulkes, A. S., Bassett, I. V., Hsu, J., Meigs, J. B., Leong, A., Putman, M. S., Triant, V. A., Wexler, D. J., & Manne-Goehler, J. (2020). Diabetes as a risk factor for poor early outcomes in patients hospitalized with covid-19. Diabetes Care, 43(12), 2938–2944. https://doi.org/10.2337/dc20-1506
Setiawan, A., Pudjonarko, D., & Tugasworo, D. (2015). Pengaruh Pemberian Deksametason Terhadap Kadar D Dimer Plasma pada Pasien Tumor Otak. 3(1), 25–31.
Silver, B., Ramaiya, K., Andrew, S. B., Fredrick, O., Bajaj, S., Kalra, S., Charlotte, B. M., Claudine, K., & Makhoba, A. (2018). EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Therapy, 9(2), 449–492. https://doi.org/10.1007/s13300-018-0384-6
Tamez-Pérez, H. E. (2015). Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World Journal of Diabetes, 6(8), 1073. https://doi.org/10.4239/wjd.v6.i8.1073
The RECOVERY Collaborative Group. (2021). Dexamethasone in Hospitalized Patients with Covid-19. New England Journal of Medicine, 384(8), 693–704. https://doi.org/10.1056/nejmoa2021436
Tjokroprawiro, A., Setiawan, P. B., Santoso, D., Soegianto, G., & Rahmawati, L. D. (2015). No TitleBuku Ajar Ilmu Penyakit Dalam : Fakultas Kedokteran Universitas Airlangga, Rumah Sakit Pendidikan Dr. Soetomo Surabaya. Buku Ajar Ilmu Penyakit Dalam (2nd ed.). (Edisi 2). Airlangga University Press.
Varghese, G., John, R., Manesh, A., Karthik, R., & Abraham, O. (2020). Clinical management of COVID-19. Indian Journal of Medical Research, 151(5), 401–410. https://doi.org/10.4103/ijmr.IJMR_957_20
WHO, W. H. O. (2020). Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Geneva: World Health Organization;, Available, 1–10. https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, 8(5), 475–481. https://doi.org/10.1016/S2213-2600(20)30079-5
Yano, A., Fujii, Y., Iwai, A., Kageyama, Y., & Kihara, K. (2006). Glucocorticoids suppress tumor angiogenesis and in vivo growth of prostate cancer cells. Clinical Cancer Research, 12(10), 3003–3009. https://doi.org/10.1158/1078-0432.CCR-05-2085
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., & Wei, Y. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan , China : a retrospective cohort study. The Lancet, 395(10229), 1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Zhu, L., She, Z. G., Cheng, X., Qin, J. J., Zhang, X. J., Cai, J., Lei, F., Wang, H., Xie, J., Wang, W., Li, H., Zhang, P., Song, X., Chen, X., Xiang, M., Zhang, C., Bai, L., Xiang, D., Chen, M. M., … Li, H. (2020). Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism, 31(6), 1068-1077.e3. https://doi.org/10.1016/j.cmet.2020.04.021
Copyright (c) 2024 Didik Hasmono, Hasbi As-Shiddiq, Anissah Insyirah Idris, Ruddy Hartono, Mohammad Subhan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.