The number of new crown cases has increased again. During the epidemic, blood sugar management should pay attention to this indicator.

*It is only for medical professionals to read for reference.
During the epidemic, it is necessary to actively use basal insulin to control fasting blood glucose levels
.

The global novel coronavirus pneumonia (COVID-19) epidemic has entered a stalemate, and foreign countries where there is no active prevention and control and comprehensive vaccination (such as India) have severe epidemics, and mutated virus strains have been discovered continuously
.

Domestic port cities such as Guangzhou and Shenzhen continue to have imported domestic and overseas cases, and more than 100 new cases have been added recently
.

In addition, there is an immune gap in global vaccination, and virus mutations will have a serious impact on epidemic management
.

Studies have suggested [1] that the effectiveness of vaccines against mutated viruses may be questionable at this stage, and the pressure of epidemic prevention and control will continue in the recent period
.

 For diabetic patients, blood sugar management should be paid more attention during the COVID-19 epidemic
.

A recent study [2] pointed out that diabetic patients admitted to the hospital due to COVID-19 have a poorer prognosis and a higher risk of admission to the intensive care unit (ICU), leading to an increased risk of death
.

So, during the epidemic, how can we strengthen the blood sugar management of diabetic patients? Elevated fasting blood sugar can worsen the prognosis of COVID-19 patients! More and more studies have begun to analyze the reasons for the poor prognosis of diabetic patients with COVID-19.
Recent analysis has prompted the following two conclusions: Increased fasting blood glucose increases the risk of death from COVID-19
.

Studies [3] suggest that fasting blood glucose (FPG) ≥7.
0 mmol/L can predict the poor prognosis of COVID-19 hospitalized patients and is an independent risk factor for death
.

Elevated fasting blood glucose increases the risk of patients entering the ICU for treatment
.

Another recent study pointed out [4] that even a small increase in the normal range of FPG is associated with a significant increase in the risk of COVID-19 patients admitted to the ICU
.

 The above results suggest that in the context of the epidemic, more attention should be paid to the FPG level of diabetic patients.
Even a small increase within the normal range may have an impact on the prognosis of patients
.

FPG≤6.
1mmol/L, regardless of the epidemic situation or not, the standard cannot be relaxed! First of all, the goal of FPG control for diabetic patients should be clarified
.

A study conducted in the Chinese population [5] included more than 1,000 participants with normal blood sugar or hyperglycemia and found that when FPG>6.
1mmol/L, the ability to secrete early-phase insulin is only about 50%
.

Therefore, achieving FPG≤6.
1mmol/L will help delay the failure of β-cell function
.

 In addition, the BEYOND III study for the Chinese population shows that for most Chinese T2DM patients, in order to achieve the goal of glycosylated hemoglobin (HbA1c) <7%, setting the FPG target value to 6.
1mmol/L can increase the rate of compliance and not Increase the risk of hypoglycemia (Figure 1) [6]
.

The post-mortem analysis [7] also found that when the FPG is 6.
1mmol/L, the corresponding HbA1c is 7.
0%, which is linearly correlated.
These two blood glucose levels are in line with the American Academy of Clinical Endocrinologists (AACE)/American Society of Endocrinology (ACE) The goals of FPG and HbA1c recommended by the guidelines are the same [8]
.

It is also based on the above evidence that the 2020 version of the "Chinese Expert Guidance and Recommendations for the Clinical Application of Basic Insulin in Adults with Type 2 Diabetes" also recommends [9] to set the blood glucose control target for most non-pregnant adults with type 2 diabetes to FPG≤6.
1mmol /L, HbA1c<7%
.

It can be seen that FPG≤6.
1mmol/L should be a new standard for blood glucose management in patients with type 2 diabetes [7], and it is also a glucose control goal for reducing the risk of events in diabetic patients during the epidemic
.

Figure 1 When FPG≤6.
1mmol/L, the patient's HbA1c compliance rate is high and does not increase the risk of hypoglycemia.
Basic insulin helps stabilize and safely control sugar.
The above evidence suggests the importance of controlling FPG ≤6.
1mmol/L during the COVID-19 epidemic
.

 The 2020 version of "China Type 2 Diabetes Prevention Guidelines"[10] clearly pointed out that for patients whose blood glucose has not yet reached the control target (HbA1c≥7%) based on the combined treatment of life>
.

The BEYOND III study [6] showed that after 24 weeks of insulin glargine treatment, 67.
6% of patients achieved FPG≤6.
1mmol/L, and 69% of patients achieved HbA1c<7%
.

It can be seen that patients with insulin glargine treatment are more likely to achieve the goal of FPG≤6.
1mmol/L, which helps to achieve HbA1c
.

 At present, the new generation of ultra-long-acting basal insulin glargine U300 and insulin degludec have a more stable and lasting hypoglycemic effect than traditional basal insulin [9]
.

However, in a 24-hour glucose clamp test based on the individualized insulin dosage of the patient, the PK/PD curve after 3 months of treatment with insulin glargine U300 and insulin deglu , The relative intraday variability of insulin glargine U300 was reduced by 23% (Figure 2) [11]
.

The BRIGHT study also showed that during the initial dose adjustment period, the incidence of hypoglycemia in patients using insulin glargine U300 was significantly lower than that of insulin glargine by 43% [12]
.

Figure 2 The intra-day variation of insulin glargine U300 is lower than that of insulin degluargine.
For patients with type 2 diabetes who start basic insulin therapy, the starting dose can be set at 0.
2-0.
3 U per kilogram of body weight per day, but insulin glargine U300 is at risk of hypoglycemia Lower, it is recommended to start at 0.
3U/kg [13]
.

The "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" also pointed out that for HbA1c>8%, starting from 0.
2 to 0.
3 U/kg/d; for BMI ≥ 25 kg/m2, starting at 0.
3 U/kg/d [10]
.

 In addition, in terms of dosage adjustment, insulin glargine U300 can be easily and flexibly adjusted according to FPG every day
.

The outpatient can use the 1-1-1 regimen to adjust the dose, that is, 1U per day; the ward can use the 2-4-6 regimen to adjust the dose, that is, adjust 2-6U per day, until the fasting blood glucose reaches 6.
1mmol/L[14,15]
.

In summary, in the context of the epidemic, we need to pay more attention to the importance of achieving FPG standards for diabetic patients
.

According to evidence-based evidence and relevant expert guidance and recommendations, FPG≤6.
1mmol/L can be used as the goal of patient blood glucose management
.

The basal insulin represented by insulin glargine U300 recommended by the 2020 edition of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" is a better choice for diabetic patients in the context of the epidemic.
It takes into account the effectiveness and safety of hypoglycemia, and helps patients to achieve blood glucose standards.
A powerful weapon to reduce the risk of hypoglycemia
.

"This article is only used to provide scientific information to medical and health professionals, and does not represent the position of the platform.
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[5]Pang C, et al.
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[6]Yang W, et al.
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[8]Garber AJ, et al.
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[9] Ran Xingwu, et al.
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[10] Diabetes Branch of Chinese Medical Association.
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2021;13(4) :315-409.
[11]Lucidi P, etal.
Diabetes Care.
2021Jan;44(1):125-132.
[12]Julio Rosenstock, etal.
Diabetes Care.
2018;41(10):2147-2154.
[ 13] Chinese manual for insulin glargine U300.
[14] Yale J, et al.
Can JDiabetes.
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[15] Ji Linong, et al.
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2017;25(1): 2-9.
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