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Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

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posted on 09.02.2021, 23:56 by Georgia M. Davis, Eileen Faulds, Tara Walker, Debbie Vigliotti, Marina Rabinovich, Joi Hester, Limin Peng, Barbara McLean, Patricia Hannon, Norma Poindexter, Petrena Saunders, Citlalli Perez-Guzman, Seema S. Tekwani, Greg S. Martin, Guillermo Umpierrez, Shivani Agarwal, Kathleen Dungan, Francisco J. Pasquel
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.

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