Researchers Publish Recommendations for Limiting Interactions with Hospitalized Patients with COVID-19, Diabetes

As increasing amounts of research illustrate the risk of diabetes in patients with the coronavirus disease 2019 (COVID-19), a new study has found that hospitalized patients with COVID-19 and diabetes represent more than 20% of individuals in intensive care units (ICUs).¹ This population poses a significant challenge to health care workers who need to care for these patients while avoiding exposure.¹

The findings illustrate the importance of diabetes control in patients with COVID-19, and the authors gave several recommendations for clinicians looking to limit their risk of exposure while caring for these patients. Hospitalized patients with COVID-19 and diabetes need glucose-lowering therapies in addition to the other medical management necessary for the virus, but appropriate glycemic management often requires direct patient interactions, thereby putting clinicians at risk.¹

If left untreated, the authors noted that hyperglycemia alters leukocyte function and increases the virulence of some pathogens, thereby increasing risk for infections. Research has also found that it increases the risk of cardiac arrhythmias, prolongs hospital stays, and increases mortality.¹

Normally, treatment regimens including long-acting and short- or rapid-acting insulins are recommended for achieving glycemic control. Intravenous (IV) insulin infusions are recommended for achieving glycemic targets of 140-180 mg/dl in critically ill patients.¹ Achieving these goals has been problematic, however, given the current need to avoid unnecessary interaction with patients with COVID-19.¹

“These health care providers are at risk for contracting COVID-19, and while glycemic management in the hospital improves patient outcomes, it also intensifies the amount of time with direct patient contact,” said lead author Mary Korytkowski, MD, in a statement.²

Some recommendations include minimizing the use of IV insulin infusions, using remote continuous glucose monitoring devices, and reconsidering use of non-insulin therapies. The authors added that the role of diabetes self-management by hospitalized patients has been of increasing interest.¹

Two groups of patients with COVID-19 may not require scheduled insulin therapy, according to the authors. Those with well-controlled, non-insulin treated type 2 diabetes and patients with newly recognized hyperglycemia require point-of-care blood glucose monitoring with initial use of correction insulin to achieve and maintain glycemic control, according to the authors.¹ Patients whose blood glucose levels remain below 180 mg/dl for 24-36 hours following admission can have the frequency of glycemic monitoring decreased to once or twice daily, thus minimizing direct interactions with health care providers.¹

For patients with confirmed COVID-19 who need insulin therapy, the authors said some institutions have implemented protocols adapted from previous studies for scheduled subcutaneous insulin therapy, while others have adopted approaches such as more frequently dosed intermediate-acting or premix insulin preparations.¹

The investigators noted that when discharged, many patients may be going home with a different regimen than they had upon entering the hospital, and clinicians should be sure that they understand the changes. Using technology such as telehealth can help clinicians continue to provide care without risk of contracting the virus once the patient returns home.¹

REFERENCES

• Korytkowski M, Antinori-Lent K, Drincic A, et al. A Pragmatic Approach to Inpatient Diabetes Management During the COVID-19 Pandemic. Journal of Clinical Endocrinology & Metabolism; June 5, 2020. https://www.endocrine.org/news-and-advocacy/news-room/2020/hospitalized-covid19-patients-with-diabetes-represent-more-than-20-percent-of-icu-population. Accessed June 8, 2020.
• Hospitalized COVID-19 patients with diabetes represent more than 20 percent of ICU population [news release]. Endocrine Society; June 5, 2020. https://www.endocrine.org/news-and-advocacy/news-room/2020/hospitalized-covid19-patients-with-diabetes-represent-more-than-20-percent-of-icu-population. Accessed June 8, 2020.