Sarah Piraino, PharmD, on Diabetes and COVID-19

In this podcast, Sarah Piraino, PharmD, speaks about glycemic outcomes in people with diabetes in the presence or absence of COVID-19 infection, including gaps that exist in the research and future directions regarding COVID-19 and glycemic management in people with diabetes. She presented on this topic at ADCES21. 

Additional Resources: 

• Papachristou S, Stamatiou I, Stoian AP, Papanas N. New-onset diabetes in COVID-19: time to frame its fearful symmetry. Diabetes Ther. 2021;12(2):461-464. https://doi.org/10.1007/s13300-020-00988-7 
• Zhu L, She ZG, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31(6):1068-1077.e3. https://doi.org/10.1016/j.cmet.2020.04.021 
• Piraino S, Clements J. Glycemic outcomes of people with diabetes in the presence or absence of COVID-19 infection. Talk presented at: Association of Diabetes Care & Education Specialists Conference; August 12-15, 2021; Virtual. https://adcesmeeting.org/
• Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, Klonoff DC. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States. J Diabetes Sci Technol. 2020;14(4):813-821. https://doi.org/10.1177/1932296820924469 

TRANSCRIPTION:

Jessica Bard: Hello everyone and welcome to another installment of "Podcast360," your go‑to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network.

Diabetes is identified as a significant comorbidity and mortality and poor clinical outcomes for people with COVID‑19 infection. Dr Sarah Piraino is here to speak with us about her research, glycemic outcomes of people with diabetes in the presence or absence of COVID‑19 infection presented at ADCES 2021.

Dr Piraino is a clinical pharmacist at Spartanburg Medical Center in Spartanburg, South Carolina. Thank you for joining us today. Let's dive into your study. Can you please give us an overview of your session and tell us how this study came about?

Dr Sarah Piraino: This study was originally thought of by Dr Jennifer Clements. She is a diabetes specialist who works at Spartanburg Medical Center, where I was completing my postgraduate residency training.

She thought of this because it was a unique question that had not been addressed yet, which is what are the long‑term effects of COVID‑19 on people with diabetes? We knew a lot of the research was on people with an active COVID‑19 infection. We knew that diabetes was associated with a high mortality, generally poor outcomes, a higher incidence of ICU admissions.

Overall, they were very difficult to gain glycemic control during their hospitals stay. We knew all of these things, but we didn't know what happens after this patient leaves the hospital. What are the long‑term glycemic outcomes? I thought that that was a unique question, and why I chose to work on this research because I thought it would pave the way for future research.

Jessica: Talk to us a little bit more about the study itself, or the methods that you used in your study.

Dr Piraino: Yes. This was a retrospective chart review, done on patients who were admitted to Spartanburg Medical Center, which is a 540‑bed teaching hospital in Spartanburg, South Carolina. We looked at anyone who was admitted between March 1st and July 31st, of 2020 and obviously who had a diabetes diagnosis and then had been screened for COVID‑19 infection.

Our two comparator groups were to look at COVID positive versus COVID negative patients. We were looking at their glycemic outcomes, which we measured with A1C. I collected a pre‑admission A1C, and then compare that to a post‑admission A1C, collected three to five months after they were discharged from the hospital.

We were comparing the two groups to see if someone was COVID positive, would they have a higher A1C? Then some other things that we collected as well. We're looking at their insulin doses, number of injections, as well as diabetes medications, to see whether these increase, decrease, or stay the same.

Then we were working with an in‑house statistician who ran statistical tests on all of our outcomes to see if there were any significant differences detected.

Jessica: Let's talk about the conclusions a little bit. Can you summarize the conclusions from your study? How do they impact future directions regarding COVID‑19 infection and glycemic management in people with diabetes?

Dr Piraino: Ultimately, with our study, we were not able to detect a statistically significant difference for our outcomes. This is because we were limited with a small sample size, and a large number of patients had passed away from COVID‑19.

Then there was also a lack of documentation in the electronic medical record of A1C levels. We were limited in that aspect. We had a total of 76 patients that we were able to collect data from.

There's a need for larger studies to be done looking at this, as it has implications for the outpatient management of people with diabetes. There's still questions of whether these patients need closer follow up when they're discharged from the hospital.

Do they need increases in their insulin doses or their diabetes medications? Those are all still things that we need answers to in order to provide them the best health care possible.

Jessica: What are the overall take‑home messages from your study?

Dr Piraino: The overall take‑home message is that a big gap in the literature right now that we need more studies to look into. Hopefully, my thought with this study is that it will spark more interest, and more people will start doing research and looking into what the long‑term effects of COVID‑19 are on this population.

Jessica: I think that's a good segue into the next question. Speaking of those gaps, what is next for research on this topic?

Dr Piraino: We have a tremendous amount of information of what happens when someone with diabetes has an active COVID‑19 infection. What I suspect is, now we will start adding to that body of information, by looking at what happens to people with chronic disease states after they leave the hospital.

As in the coming days, we'll definitely see more studies, more information on the long‑term effects. Then, I think that a new avenue that's really interesting is, can COVID‑19 infection cause new‑onset diabetes?

That's something that's being looked into currently is can it affect pancreatic beta‑cell function, and cause new‑onset diabetes, cause people with diabetes currently to have worsened outcomes? I think that we have a lot in the pipeline that will be coming our way.

Jessica: This is important in a world that feels like there's new information coming out every day on COVID patients. It's really important. Is there anything else that you'd like to add at all, anything that you think that we missed?

Dr Piraino: Not really, just that we're still learning a lot about COVID‑19. We've come a long way since this pandemic started. We all know someone that has diabetes, whether that's a family member, a friend, a co‑worker.

Knowing what the long‑term effects is important so we know how to bring them the best health care possible. I'm really excited to see what future research plans, and what they find to best take care of patients.

Jessica: Thank you so much for your time today. We really appreciate it. It was a pleasure speaking with you.

Dr Piraino: Thank you.