A hybrid approach integrating real-time continuous glucose monitoring (CGM) and routine point-of-care glucose testing may improve management of hospitalized, critically ill patients with COVID-19 who require insulin, according to study results published in Diabetes Care.

Researchers reported their findings from a proof-of-concept experience of 9 patients (mean age, 65.9±15.2 years) in a COVID-19 intensive care unit in Atlanta, Georgia. These patients required both mechanical ventilation and corticosteroids.

The researchers obtained point-of-care glucose values from a point-of-care glucometer and linked a hybrid CGM and point-of-care glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII). Additionally, the researchers integrated a validation system for sensor glucose values into the patients’ electronic health record.


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Validation of CGM sensors were confirmed if a less than 20% variance was observed compared with point-of-care glucose values for 2 consecutive hours. Subsequently, the investigators performed validation of sensors was assessed every 6 hours. Approximately 75.7% of sensor values that were more than 100 mg/dL were within 20% of the reference point-of-care glucose during the protocol with an associated mean 63% reduction in required point-of-care testing. The average time in range, or between glucose values of 70 to 180 mg/dL, was 71.4%±13.9%. In 4 patients, the investigators found that sensor accuracy was affected by mechanical interferences.

Limitations of this study included the small sample size as well as the inclusion of only critically ill patients from a single center.

The researchers wrote that during this time, diabetes technology may “help alleviate staff concerns related to work burden, exposure, and [personal protective equipment] consumption, while improving glycemic control during this health care crisis.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Davis GM, Faulds E, Walker T, et al. Remote continuous glucose monitoring with a computerized insulin infusion protocol for critically ill patients in a COVID-19 medical ICU: proof of concept. Diabetes Care. Published online February 9, 2021. doi:10.2337/dc20-2085