Dexamethasone not associated with survival benefit in inpatients with COVID-19, diabetes
Patients with diabetes and severe COVID-19 who were treated with dexamethasone had slower time to clinical recovery than propensity-matched patients who didn't get dexamethasone, and steroid treatment did not improve mortality, a retrospective study found.
Dexamethasone was not associated with significant improvement in survival or time to clinical improvement in patients with diabetes and COVID-19 infection.
Researchers conducted a retrospective study of data from five hospitals in a single health system from March 2020 to June 2022. The primary outcome was time to death within 28 days. Secondary outcomes were time to clinical improvement and incidence of hyperglycemic emergencies, and a subgroup analysis looked at primary outcomes by clinical severity. Results were published Oct. 17 by the Journal of Clinical Endocrinology & Metabolism.
Of more than 10,000 patients admitted for COVID-19, 3,679 had diabetes and 2,361 met the inclusion criteria. Researchers propensity-score matched 529 patients who were treated with dexamethasone with 529 who did not receive the steroid. The 28-day mortality rates were 8.7% (n=46) in the dexamethasone group and 6.4% (n=34) in the control group. There was no statistically significant difference in mortality between the dexamethasone and control groups during days 0 to 6 (adjusted hazard ratio [aHR], 0.65 [95% CI, 0.33 to 1.26]; P=0.20) or days 7 to 28 (aHR, 1.34 [95% CI, 0.64 to 2.86]; P=0.44).
The incidence of diabetic ketoacidosis (DKA) was not statistically different between the treatment and control groups, at 38 patients (7.2%) in the dexamethasone group and 34 patients (6.4%) in the control group (P=0.714). Time to clinical improvement was similar in both groups (median, five days), but the subgroup analysis by severity of illness found that patients with severe/critical COVID-19 infection had a significantly slower time to clinical improvement with dexamethasone (aHR, 0.58; 95% CI, 0.41 to 0.81)
The results offer critical insights for managing inpatient COVID-19 among patients with diabetes, the study authors wrote, namely that there was no overall benefit of dexamethasone in reducing mortality or accelerating clinical improvement among patients with diabetes. Limitations include the risk of an indication bias where sicker patients were more likely to receive dexamethasone. In addition, as a retrospective study, the research cannot establish causality.
“These findings underscore the need for further investigation through randomized controlled trials or prospective studies to better understand the implications of dexamethasone treatment in this high-risk patient population,” the authors wrote.