An audit on the use of variable rate intravenous insulin infusions (VRIII) in patients diagnosed with SARS-CoV-2

ABSTRACT

Aims: To assess VRIII utilisation in SARS-CoV-2 positive patients with diabetes mellitus at Queen Elizabeth Hospital, Birmingham, and adherence to Joint British Diabetes Society (JDBS) standards. Methods: This was a retrospective data-based study. All patients admitted to Queen Elizabeth Hospital Birmingham who tested positive for SARS-CoV-2 requiring VRIII between March and June 2020 were included in the study. Data were extracted using our electronic database Prescribing Information and Communication System (PICS). Data were collected on demographics, diabetic history and VRIII use. Primary outcome measures were substrate use, diabetes medication management, glycaemic control, adverse events as analysed by rate of hypoglycaemia, hyponatraemia and hypokalaemia and monitoring of renal function and capillary blood glucose, in accordance with the JDBS guidelines. Pre-planned subset analysis was performed based on the patient location (ward or intensive care unit (ICU)). All results are shown as median±SD. Results: A total of 85 patients were included in the study, with 55 patients treated in the ICU and 28 patients treated on the wards. The median age of ICU patients was lower than those on the wards (57±10.23 years vs 71.5±16.81 years) and BMI was higher (29.7±6.56 kg/m2 vs 27.8±6.43 kg/m2). The percentage of male patients in ICU was higher compared with those on the wards (76.4% (42/55) vs 53.6% (15/28)). The substrate was used appropriately in 53.3% of VRIII episodes on the ward compared with only 5.4% on ICU. This was due to the concomitant use of NG feeds in 90%. Daily monitoring of electrolytes whilst on a VRIII was higher in the ICU (94.5%, 52/55) than on the ward (71.42%, 21/28). Long-acting insulin was continued in 100% of all type 1 diabetes in both wards and ICU. Median VRIII duration was higher in ICU, given prolonged stay and patients being more unwell, than on the ward (233±184.32 hours vs 14.5±52.26 hours). Target glycaemic control whilst on VRIII was better achieved in the ICU than on the wards. Conclusion: Intensive care with close monitoring has demonstrated better adherence to VRIII as outlined by JBDS for management of hyperglycaemia in patients with diabetes and COVID-19. The longer use of VRIII in unwell ICU patients may reflect higher insulin insensitivity. A further interventional multicentre study is required to gain further insight.