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

Abstract

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.

Recommendations on the use of the flash continuous glucose monitoring system in hospitalized patients with diabetes in Latin America

“…Finally, the average glucose was also significantly associated with percentage of time in hypoglycaemia (p = 0.003), percentage of time in range (p = 0.01), and HbA1c (p = 0.046). These providing an innovative approach for hospitalized patients with diabetes in different scenarios where glucose control remains a key element of their management [ 16 ].…”

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“…Finally, the majority of studies describe the use of wearable technology in the home or an ambulatory setting. However, wearable devices outside nephrology have been shown to have a clinical utility in the inpatient setting for both diabetes control [ 85 ] and the treatment of decompensated heart failure [ 86 ], which bears consideration. Wearables may help reduce pressure on stretched resources, such as healthcare providers spending time on traditional phlebotomy, erroneous timing of samples such as tacrolimus or vancomycin levels, and reliance on traditional inpatient dialysis machines, and may help guide therapy such as more personalised diuresis.…”