The coronavirus disease 2019 global pandemic continues to spread worldwide with approximately 216 million confirmed cases and 4.49 million deaths to date. Intensive efforts are ongoing to combat this disease by suppressing viral transmission, understanding its pathogenesis, developing vaccination strategies, and identifying effective therapeutic targets. Individuals with preexisting diabetes also show higher incidence of COVID-19 illness and poorer prognosis upon infection. Likewise, an increased frequency of diabetes onset and diabetes complications has been reported in patients following COVID-19 diagnosis. COVID-19 may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is unclear whether the virus induces type 1 or type 2 diabetes or instead causes a novel atypical form of diabetes. Moreover, it remains unknown if recovering COVID-19 patients exhibit a higher risk of developing new-onset diabetes or its complications going forward. The aim of this review is to summarize what is currently known about the epidemiology and mechanisms of this bidirectional relationship between COVID-19 and diabetes. We highlight major challenges that hinder the study of COVID-19-induced new-onset of diabetes and propose a potential framework for overcoming these obstacles. We also review state-of-theart wearables and microsampling technologies that can further study diabetes management and progression in new-onset diabetes cases. We conclude by outlining current research initiatives investigating the bidirectional relationship between COVID-19 and diabetes, some with emphasis on wearable technology. Coronavirus disease 2019 (COVID-19) is a global pandemic responsible for approximately 216 million confirmed cases and 4.49 million deaths that continues to spread rapidly (1). The virus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China, in 2019 and spreads via droplet transmissions, leading to variable symptoms that can range from asymptomatic or mild respiratory illness to severe multiorgan failure and death in infected individuals. Individuals with type 1 diabetes (T1D) or type 2 diabetes (T2D) often have comorbidities such as hypertension, obesity, and cardiovascular disease (2), all of which have also been implicated in increased susceptibility to and mortality from COVID-19 infection (3). Similar to the SARS-CoV-1 outbreak in 2003 (4) and respiratory syncytial virus infection (5), there is an increase in hyperglycemic conditions and complications in COVID-19 patients both with and without diabetes. Specifically, new-onset diabetes has been observed following COVID-19 infection (6), including acute hyperglycemia in COVID-19 patients without diabetes, diabetic ketoacidosis in COVID-19 patients with preexisting diabetes, and newonset diabetes in 8).Given the evolving nature of the COVID-19 pandemic, it is not yet known whether new-onset SARS-CoV-2-induced diabetes occurs via established mechanism...

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Deployment and maturation of computerized medical records has improved insight into the unintended variability of glucose management in hyperglycemic inpatients. We used expert panels and extensive field testing to design a Glycemic Management Program to simultaneously reduce mean glucose levels and the frequency of hypoglycemic events. Factors observed as contributing to glucose control variation included over-use of sliding scale insulin; inconsistencies in timing, type and dose of insulin; and the alignment of blood glucose testing with meal tray delivery. We designed our Glycemic Management Program to address these factors with four distinct components: 1) Change management via targeted education; 2) Standardization of the ordering process for nutrition, blood glucose monitoring frequency, and a single subcutaneous insulin order set with decision support; 3) Standardization of workflow, including the timing and coordination of glucose testing and meal tray delivery; and 4) Patient specific, customized ongoing insulin dosing recommendations through FDA-approved decision support software. We implemented our Glycemic Management Program pilot in a 325 bed community hospital in the southeastern United States. Since its launch, 2277 patients have been managed on the program. By six months post-implementation, the rate of severe hypoglycemia (<54mg/dL) decreased 32.2% and basal-bolus insulin usage increased 135%. Average daily glucose values decreased without increasing the rate of hypoglycemia. Decreases were observed in overall length of stay (79%), complication rate (25.3%) and ICU length of stay (60%). A comprehensive program that incorporates decision support with attention to workflow, provider engagement, and education can result in improved glucose management in an inpatient setting. Feedback has led to programmatic changes to maximize positive outcomes and ensure sustainability. Disclosure R. Freeman: None. W.E. Gay: None. T.L. Garthwaite: Advisory Panel; Self; Ondine Biomedical. L. Hollis: None. J. McCannon (Bush): None. C. Spencer-Smith: None. E.E. Samuelson: None. P. Mehta: None.