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

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.

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

“…Sensor insertion was done by a trained nurse, nurse practitioner or healthcare professional in most of the studies [ 35 – 37 , 38 ▪▪ , 39 , 42 , 43 ]. For the studies using Dexcom G6 system, glucose data was transmitted to Dexcom receivers [ 36 , 42 ], Android phones [ 38 ▪▪ ] or both iPad and iPhones [ 35 ] and were placed close to the patient's room.…”

“…Gomez et al used Freestyle Libre CGM to examine the association of glycemic control metrics with clinical outcomes in the ICU and non-ICU setting [ 43 ]. No differences were seen in TIR, TAR, TBR, coefficient of variation or glucose management indicator in patients with or without admission to ICU, ARDS or AKI, or with the composite metric of these complications.…”

Implementation of Continuous Glucose Monitoring in Critical Care: A Scoping Review

“…All 16 articles included in the review were original research studies. Included studies represented a wide variety of methodological approaches including: randomized controlled trial (n = 4) [14,15,16,17], retrospective cohort studies (n = 7) [4•, 5•, 6•, 8, 10, 18, 19•, 20], prospective cohort studies (n = 3) [9,21,22], quasi-experimental (n = 1) [23], and qualitative (n = 1) designs [24]. Eight studies included implementation and clinical data collected during the COVID-19 pandemic [4•, 5 [18,26], in the pediatric ICU (PICU) [27], and in a cardiac ICU (n = 1) [28].…”

CGM in the Hospital: Is It Ready for Prime Time?

“…MARD between Libre CGM and POC AccuChek glucoses was 15.6% with a mean relative difference between Libre CGM and AccuCheck −11.4% [ 49 ]. A second study of Freestyle Libre flash CGM in 60 ICU and non-ICU patients with COVID-19 infection and hyperglycemia or diabetes showed that glycemic monitoring using flash CGM (scanned at least 3 times daily) and a basal bolus insulin regimen was effective in achieving time in range of 72.5% [ 51 ]. Higher time above range > 180 mg/dl was associated with greater rates of a composite of complications [ 51 ].…”

“…A second study of Freestyle Libre flash CGM in 60 ICU and non-ICU patients with COVID-19 infection and hyperglycemia or diabetes showed that glycemic monitoring using flash CGM (scanned at least 3 times daily) and a basal bolus insulin regimen was effective in achieving time in range of 72.5% [ 51 ]. Higher time above range > 180 mg/dl was associated with greater rates of a composite of complications [ 51 ]. This study confirms other studies showing acceptable agreement between the POC glucose values and CGM values and serum glucose and CGM values.…”