Glycemic control metrics using flash glucose monitoring and hospital complications in patients with COVID-19

• Authors: Ana Maria Gómez, Pontificia Universidad Javeriana; Diana Cristina Henao, Pontificia Universidad Javeriana; Oscar Mauricio Muñoz, Pontificia Universidad Javeriana; Pablo Aschner, Pontificia Universidad Javeriana; Carlos Augusto Yepes, Pontificia Universidad Javeriana; Ruby Jojoa, Pontificia Universidad Javeriana; Alfonso Kerguelen, Pontificia Universidad Javeriana; Dario Parra, Pontificia Universidad Javeriana; Pablo Jaramillo, Pontificia Universidad Javeriana; Guillermo Umpierrez, Emory University
• Journal Title: Diabetes and Metabolic Syndrome: Clinical Research and Reviews
• Volume: Volume 15, Number 2
• Publisher: Elsevier | 2021-03-01, Pages 499-503
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.dsx.2021.02.008
• Subjects: Health Sciences, Public Health; Health Sciences, Medicine and Surgery
• Keywords: Basal bolus; COVID-19; Flash glucose monitoring; Inpatient; Type 2 diabetes; Acute Kidney Injury; Aged; Blood Glucose; COVID-19; Cohort Studies; Colombia; Diabetes Mellitus, Type 2; Female; Glycated Hemoglobin A; Glycemic Control; Humans; Hyperglycemia; Hypoglycemic Agents; Insulin; Intensive Care Units; Male; Middle Aged; Monitoring, Physiologic; Pilot Projects; Point-of-Care Testing; Prospective Studies; Respiratory Distress Syndrome; SARS-CoV-2

Abstract

Background and aims: Few studies have reported on the use of continuous glucose monitoring (CGM) during the Covid-19 pandemic. We aimed to examine glycemic control metrics using flash glucose monitoring during insulin treatment and the clinical outcome in hospitalized patients with COVID-19. Methods: Prospective, single-center cohort of adult patients diagnosed with type 2 diabetes or hyperglycemia and COVID-19 infection treated with basal bolus insulin regimen. Glycemic control was assessed with the use of intermittent Freestyle Libre flash glucose monitoring during the hospital stay. Outcome of interest were time in range [TIR], time above [TAR] and below [TBR] range, glycemic variability [coefficient of variation [% CV]), and differences in a composite of complications including ICU admission, acute respiratory distress syndrome (ARDS) and acute kidney injury. Results: A total of 60 patients were included (44 known diabetes and 16 new onset hyperglycemia). In total 190,080 data points of CGM were available, of which 72.5% of values were within the target area [TIR (70–180 mg/dL)], 22% TAR (>180 mg/dL), and 3% were TBR (<70 mg/dL). During treatment, the coefficient of variation (% CV) was 30%. There were no association with TIR, but patients with TAR >180 mg/dl had higher rates of a composite of complications (22.5% vs 16%, p = 0.04). Conclusions: Basal bolus insulin regimen was safe and effective in achieving inpatient glycemic control in most patients with COVID-19. The association between TAR and complications indicates the need for improved inpatient glycemic control in hospitalized patients with COVID-19.