Improving monitoring and treatment of dexamethasone induced hyperglycaemia in patients with covid-19

ABSTRACT

Aims: The use of dexamethasone has increased since its benefit in treating covid-19 was discovered. Hyperglycaemia has been shown to be associated in poorer outcomes in patient with covid-19. The aim of this audit was to improve monitoring and management of hyperglycaemia in covid-19 patients on dexamethasone. Methods: In October 2020 the notes of ten patients on dexamethasone for covid-19 were audited over a 1-week period to determine if they had a glucose chart present, if they were having glucose checked four times daily, and if raised glucose was appropriately actioned upon. Following this a covid-19 bundle was created to improve management of covid-19. This included guidance on monitoring and treatment of hyperglycaemia, with an aim for this to be placed in all patients notes with confirmed covid-19. The bundle was based on covidDiabetes guidance from the national inpatient diabetes covid-19 response team. Re-audit was then performed in January 2021 for a total of seven patients. Results: In October 2020 80% of patients were having their glucose levels checked, improving to 100% by January. Appropriate frequency of checking glucose improved from 20% to 57%. Appropriate actioning of hyperglycaemia, if required, improved from 50% to 75%. Conclusion: Providing local education regarding the guidelines for dexamethasone associated hyperglycaemia in covid- 19 patients can improve both management and monitoring of hyperglycaemia. Ongoing education is required for both medical and nursing staff to ensure ongoing development in recognition and management of hyperglycaemia.