Feasibility of Inpatient Continuous Glucose Monitoring During the COVID-19 Pandemic: Early Experience

Abstract

Continuous glucose monitoring (CGM) systems have been explored in a few studies for non-intensive care unit (ICU) patients (1-3). During the coronavirus disease 2019 (COVID-19) pandemic, shortage of personal protective equipment (PPE) became a concern. On 1 April 2020, the U.S. Food and Drug Administration announced it would not object to the use of CGM systems to assist with COVID-19 patient monitoring (4). This study was conducted to explore the feasibility of using CGM in noncritically ill patients hospitalized with COVID-19. Non-ICU adult COVID-19-positive patients receiving subcutaneous insulin injection and point of care (POC) glucose testing (Accu-Chek Inform II) were eligible to participate. Exclusion criteria included unstable glucose levels (POC glucose ,70 or .350 mg/dL) at entry, hypotension, significant edema, being on dialysis, being postsurgical or with planned surgery/computed tomography/ MRI, and taking hydroxyurea, ascorbic acid, or acetaminophen .1 g every 6 h. Participants gave informed consent. The protocol was approved by the Institutional Review Board at the University of Illinois at Chicago.

Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

“…28-30 While there are no guidelines for a threshold MARD that is considered acceptable in critically ill patients, one recent letter published about Dexcom G6 use in noncritically ill COVID-19 inpatients reported a MARD of 9.77% using capillary blood glucose as the reference. 31 In the complicated, critically ill patient with COVID-19, a higher MARD would be expected than in outpatient studies or inpatient studies in noncritically ill patients. Given this context, the accuracy of the results we found was above our expectations.…”

How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit

“…54 Several case reports/series have been published, demonstrating the initial feasibility of remote glucose monitoring and insulin adjustment based on monitoring with a CGM. [55][56][57] In addition, CSII/AID systems could also be utilized in selected patient populations in both the ICU and floor settings to potentially improve glycemic outcomes and reduce work burden. 51,58 However, implementation of any of these technologies requires an approach that is collaborative/teambased and allows for close follow-up and adaptation if needed over time.…”

Continuous Glucose Monitoring in the Operating Room and Cardiac Intensive Care Unit

“…Despite limited experience, the U.S. Food and Drug Administration is not objecting to the inpatient use of CGM to limit the exposure of health care workers to severe acute respiratory syndrome coronavirus 2 and to reduce the waste of personal protective equipment (1). Recent efforts in non-intensive care unit (ICU) patients suggest that CGM devices are accurate in the inpatient setting and can help monitor patients remotely (2,3). In addition, two recent small trials enrolling non-ICU patients confirm the feasibility of using remote real-time CGM in the hospital (4,5).…”