ABSTRACT
Background: COVID-increases risk of DKA and poor outcomes in patients with diabetes. Methods: A retrospective review was conducted of 4,959 DKA admissions from 1/1/2019-12/31/2021 at our hospital system. EHR data was collected on consecutive admissions coded with DKA for clinical characteristics, hospital outcomes of length of stay (LOS) , 30day readmission (30d RADM) and mortality. Data was analyzed for differences stratified by year 20vs. 2020 and 2021, and by COVID-infection. Results: Compared to 2019, patients in 2020 were older, more Hispanic and had CHF. Compared to 2019, patients in 2021 had less HTN and kidney disease but similar rates of CHF;Table 1. Mortality and LOS were higher for 2020 and 2021 while 30d RADM was lower;Table 2. Conclusion: Despite advancements in COVID-treatments, DKA patients have progressively poorer outcomes.
ABSTRACT
BACKGROUND: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). METHODS: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. RESULTS: CGM devices were placed on 11 patients: Medtronic (n = 6) and Dexcom G6 (n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of -17.76 mg/dL (Medtronic) and -1.94 mg/dL (Dexcom), with wide 95% limits of agreement. CONCLUSIONS: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.
Subject(s)
Blood Glucose/analysis , Coronavirus Infections/blood , Coronavirus Infections/therapy , Critical Illness/therapy , Monitoring, Physiologic/instrumentation , Pneumonia, Viral/blood , Pneumonia, Viral/therapy , Adult , Aged , Betacoronavirus/physiology , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose Self-Monitoring/methods , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Critical Illness/epidemiology , Critical Illness/mortality , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Diabetes Mellitus/therapy , Feasibility Studies , Female , Humans , Hyperglycemia/blood , Hyperglycemia/diagnosis , Hyperglycemia/mortality , Hyperglycemia/therapy , Insulin/administration & dosage , Insulin Infusion Systems , Intensive Care Units , Male , Middle Aged , Monitoring, Physiologic/methods , Pandemics , Pilot Projects , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Point-of-Care Systems , Prognosis , Reproducibility of Results , Retrospective Studies , SARS-CoV-2Subject(s)
Blood Glucose Self-Monitoring/methods , Coronavirus Infections/epidemiology , Critical Care/trends , Diabetes Mellitus, Type 2/therapy , Endocrinology/trends , Pneumonia, Viral/epidemiology , Blood Glucose/analysis , COVID-19 , Cell Phone , Critical Care/methods , Endocrinology/methods , Humans , Insulin Infusion Systems , Insulin Resistance , Intensive Care Units , Pandemics , Personal Protective Equipment , User-Computer InterfaceABSTRACT
CONTEXT: While individuals with diabetes appear to be at similar risk for SARS-CoV-2 infection to those without diabetes, they are more likely to suffer severe consequences, including death. Diabetic ketoacidosis (DKA) is a common and potentially lethal acute complication of diabetes arising from a relative insulin deficiency, which occurs more often in those with type 1 diabetes and in the setting of moderate to severe illness. Early reports indicate that among patients with pre-existing diabetes, DKA may be a common complication of severe COVID-19 and a poor prognostic sign. CASE DESCRIPTION: This clinical perspective explores the key elements of caring for individuals with DKA during the COVID-19 pandemic through 2 cases. Topics addressed include diagnosis, triage, and the fundamental principles of treatment with a focus on the importance of characterizing DKA severity and medical complexity to determine the best approach. CONCLUSIONS: As discussed, some tenets of DKA management may require flexibility in the setting of COVID-19 due to important public health goals, such as preventing transmission to highest risk individuals, reducing healthcare worker exposure to infected patients, and preserving personal protective equipment. Evidence for alternative treatment strategies is explored, with special attention placed on treatment options that may be more relevant during the pandemic, including use of subcutaneous insulin therapy. Finally, DKA is often a preventable condition. We include evidence-based strategies and guidance designed to empower clinicians and patients to avoid this serious complication when possible.