Objective: The use of remote
real-time continuous glucose monitoring (CGM) in the hospital has rapidly
emerged to preserve personal protective equipment (PPE) and reduce potential exposures
during COVID-19.
Design and Methods: We linked a hybrid CGM and point-of-care (POC)
glucose testing protocol to a computerized decision support system for
continuous insulin infusion (CII) and integrated a validation system for sensor
glucose values into the electronic health record. We report our
proof-of-concept experience in a COVID-19 ICU.
Results: All nine patients
required mechanical ventilation and corticosteroids. Seventy six percent of
sensor values were within 20% of the reference POC glucose with an associated
average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%.
Sensor accuracy was impacted by mechanical interferences in four patients.
Conclusions: A hybrid
protocol integrating real-time CGM and POC is helpful for managing critically
ill patients with COVID-19 requiring insulin infusion.
Funding
This work was supported in part by grant P30DK111024 from the Georgia Center for Diabetes Translation Research funded by the NIDDK (FJP). GMD is supported in part by NIH under Award Number 1K23DK122199-01A1. GEU is partly supported by research grants from the NIH/NATS UL1 TR002378 and 1P30DK111024-01 and has received unrestricted research support from Sanofi, Novo Nordisk, and Dexcom. SA is supported in part by NIH under Award Numbers K23DK115896 and P30DK111022. KMD has received research support from Eli Lilly, Novo Nordisk, Abbott, Sanofi Aventis, and Viacyte and consulting/advisory fees from Eli Lilly and Nova Biomedical. FJP is supported in part by NIH under Award Numbers 1K23GM12822101A1, P30DK111024, and P30DK11102405S1 and has received research support from Dexcom and Merck and consulting fees from Boehringer Ingelheim. The rest of co-authors report no relevant conflicts of interest related to this work.
