Caring for Hospitalized Patients with Diabetes Mellitus, Hyperglycemia, and COVID-19: Bridging the Remaining Knowledge Gaps

Wallia, Amisha; Prince, Grace; Touma, Emilie; Muayed, Malek El; Seley, Jane Jeffrie

doi:10.1007/s11892-020-01366-0

Cited by 21 publications

(19 citation statements)

References 103 publications

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“…Of note, this pilot was performed before the widespread use of dexamethasone as a treatment for COVID-19, and, hence, it is plausible that later cohorts of patients receiving dexamethasone as COVID-19 treatment may subsequently exhibit increased glucose levels. As obesity is an additional key risk factor for adverse COVID-19 related outcomes, 23 – 27 these findings further highlight the need for careful glucose monitoring during the hospital care of patients with T2DM and COVID-19. The present findings did not show significant associations between the length of stay of the recruited inpatients and key glucose control parameters based on the flash monitoring readings, potentially due to the small sample size of this pilot.…”

Section: Discussionmentioning

confidence: 86%

“…Finally, statistically significant associations were also noted between different measures of glycaemic control (including time in range, time in hyperglycaemia time in hypoglycaemia, average glucose, and HbA1c; Table 3 ), which are important surrogate markers shown to have an impact on outcomes for patients with COVID-19 and diabetes 23 – 26 . Notably, the FDA has issued guidance for the US on the potential use of flash glucose monitoring devices in the hospital setting during the COVID-19 pandemic ( www.fda.gov/medical-devices/blood-glucose-monitoring-devices/faqs-home-use-blood-glucose-meters-utilized-within-hospitals-during-covid-19-pandemic ), and approaches similar to the one we describe in this UK pilot are also being explored abroad, mainly in the US 26 – 31 .…”

Section: Discussionmentioning

confidence: 99%

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Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

et al. 2022

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Background COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19. Methods Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay. Results During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). Discussion We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

et al. 2022

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“…In corona patients with diabetes, one of the most important care is to check blood sugar by the patient's bed 32 . The results of our study also show that one of the cares that have the least loss rate is checking blood sugar by the patient's bed, and this shows the nurses' attention to the importance of this issue.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the time spent at the patient's bedside and reducing the time of face-to-face care in corona patients is one of the basic principles to minimize the spread of infection 32 , which can be the reason for the missed secondary and supportive care.…”

Section: Discussionmentioning

confidence: 99%

Missed Nursing Care in COVID-19 Patients in Iran

Hosseini¹,

Reisi²,

Maghari³

et al. 2021

Preprint

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ObjectivesNursing care is one of the most important tasks of nursing. Providing safe and high-quality nursing care will improve the patient as soon as possible and reduces the complications of the disease. Due to the corona epidemic in the last year, nurses cannot provide all the necessary care for patients; a series of care is eliminated or delayed or reduced, which is called missed nursing care. So, this study aimed to investigate the missed nursing care and the reasons affecting it in the corona wards in Ardabil.Study designThe research is conducted in a cross-sectional manner. The research included 135 nurses who worked in Ardabil's corona wards.Data collection/extraction methodsThe Missed Nursing Care Questionnaire, was used to collect data. The significance level of statistical tests set at 0.05.Principal findingsMost of whom were women, 135 nurses participated in the study and had a bachelor's degree in nursing. Supportive and necessary care is missed more than other care; According to nurses, the most common reasons for the missed care were emergencies, low staffing, and an increase in the number of patients.ConclusionsAs a result of the findings, being in a fresh and uncertain situation, as well as an increase in the number of patients, has resulted in a loss of nursing care. By controlling these factors, the missed care in the ward can be controlled, and increase the satisfaction of patients and nurses.

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“…Around 10.3% patients without pre-existing diabetes had a random plasma glucose > 200 mg/dL on admission labeled as ‘new-onset hyperglycemia’. Impaired glucose regulation is typically seen in COVID-19 patients leading to new-onset hyperglycemia, worsening control in DM, severe insulin resistance requiring high insulin dosages and even diabetic ketoacidosis (DKA) ( 27 , 28 , 29 , 30 ), and these are associated with increased levels of inflammatory cytokines ( 31 ). These changes can affect the functions of the skeletal muscle and liver, the organs responsible for the bulk insulin-mediated glucose uptake ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

Kumar

Mittal

Gopalakrishnan

et al. 2021

Endocrine Connections

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Objective: Plasma glucose has been correlated with in-hospital mortality among many diseases including infections. We aimed to study plasma glucose at admission of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India and its relation with mortality. Design: A hospital-based clinical study of plasma glucose of COVID-19 patients conducted from May 15th to June 30th, 2020 after ethical approval. Measurements: Random blood samples at admission were collected for plasma glucose, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) after written informed consent. Plasma glucose was analyzed by automated analyzer, IL-6 by chemiluminescent immunoassay and hsCRP by immune-turbidimetric assay. Results: A total of 386 patients studied (female 39.6%); 11.1% had severe disease and 4.1% expired. There were 67 (17.4%) patients with known diabetes mellitus (DM). Patients with history of DM had three times higher mortality (6/66, 9%) than those without DM (10/319, 3.1%). Patients with moderate and severe disease according to ICMR and WHO grading had higher plasma glucose than those with asymptomatic or mild disease (p<0.0001). Plasma glucose levels at admission were significantly higher in non-survivors when compared to those who survived (297±117 vs. 131±73; p<0.0001). COVID-19 patients showed increasing mortality with incremental plasma glucose levels. Hazard ratio for mortality was 1.128 (95%CI 0.86-14.860),1.883 (95%CI 0.209-16.970), and 4.005 (95%CI 0.503-32.677) in random plasma glucose group of >100-200, >200-300 and >300mg/dl respectively compared to those with random plasma glucose of <100mg/dl at admission. Plasma glucose was strongly correlated with hsCRP (p<0.001) and IL-6 (p<0.0001). Conclusions: Plasma glucose at admission in hospitalized COVID-19 patients is a strong predictor of mortality.

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Caring for Hospitalized Patients with Diabetes Mellitus, Hyperglycemia, and COVID-19: Bridging the Remaining Knowledge Gaps

Cited by 21 publications

References 103 publications

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

Missed Nursing Care in COVID-19 Patients in Iran

Effect of plasma glucose at admission on COVID-19 mortality: experience from a tertiary hospital

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