Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Abstract

The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.

Clouds and Silver Linings: COVID-19 Pandemic Is an Opportune Moment to Democratize Diabetes Care Through Telehealth

“…Although the use of existing wearable technologies to generate data is not an absolute requirement, having access to timely and accurate diabetes and other related health data is likely to facilitate better outcomes associated with telehealth. 1 With the current pandemic, there is also a need to maintain optimized glucose management as a protection against poor outcomes associated with COVID-19. 2 Optimal glucose management is more likely to be achieved using telehealth that includes technologies that provide opportunities for data sharing, such as Bluetooth-enabled blood glucose monitoring systems, digital blood pressure measuring devices, electronic scales, personal continuous glucose monitoring (CGM), and potentially, smart insulin pens.…”

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

“… General Hyperglycemia without diabetes ICU (n = 13) No ICU (n:47) p ARDS (n = 15) No ARDS (n = 45) p AKI (n = 13) No AKI (n = 47) p ICU (n = 5) No ICU (n = 7) p ARDS (n = 4) No ARDS (n = 8) p AKI (n = 3) No AKI (n = 9) p %TIR, median (IQR) 73 (62–86) 72 (54–89) .68 73 (38–90) 72 (55–85) .95 68 (54–86) 73 (54–90) .77 86 (80–90) 75 (56–95) .56 88 (77–94) 77,5 (64,5–95) .49 73 (68–86) 90 (75–95) .30 %TAR, median (IQR) 18 (6–29) 20 (4–46) .71 18 (6–61) 20 (4–40) .47 23 (12–42) 14 (3–40) .22 6 (0–12) 3 (0–5) .67 9 [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] 2 (0–4,5) .26 …”

“…During the COVID-19 pandemic, critical shortages of personal protective equipment (PPE) has resulted in increasing hospital use of CGM to minimize bedside encounters [ 6 , 7 ]. The result of preliminary studies have indicated that CGM readings correlates well with point of care capillary glucose testing in hospitalized patients with COVID-19, and provides an attractive option to for the management of general medicine and surgery patients with diabetes [ 8 , 9 ].…”

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

“…4 Despite limited guidance, established studies, or widespread support from the clinical community to use CGMs in acute care, 6 some healthcare professionals (HCPs) in the hospital diabetes community have recently begun to prescribe CGMs in the hospital setting for investigational or off-label use for COVID-19 patients. 7 The Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel included professionals from a variety of backgrounds. Members included experts in the use of CGMs from adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law.…”

“…4 Despite limited guidance, established studies, or widespread support from the clinical community to use CGMs in acute care, 6 some healthcare professionals (HCPs) in the hospital diabetes community have recently begun to prescribe CGMs in the hospital setting for investigational or off-label use for COVID-19 patients. 7…”