Premix Analog Insulin regimen is a Pragmatic approach in patients with T2DM with Mild to Moderate COVID-19 managed through Teleconsultations

ABSTRACT

Objective: Uncontrolled hyperglycaemia is associated with poor clinical outcomes in patients with COVID-19. Basal-bolus (BB) insulin regimen is recommended for intensification and is safe and effective. However, this is complex in COVID era, especially for initiation with challenges in deployment of healthcare personnel with gaps in required expertise. Hence, implementation of an effective insulin therapy is challenging. Methods: We evaluated the impact of initiating premix analog insulin regimen (PA) in T2D patients diagnosed with COVID-19 during the second wave of the pandemic (n=434), who consulted virtually. Insulin initiation was based on random blood sugar (RBS) as reported through SMBG by the patients who were already under regular care, across two dedicated diabetes management centres. Patients were advised to contact over Whatsapp in case self-reported RBS was above 300 mg/dL Results: The mean age of the patients was 59 years (SD±13, 95% CI 58 to 60). 256 were male. 48 patients (11%) were started with basal insulin (43 glargine, 5 degludec) and were optimally managed by dose uptitration. There were 92 patients (21.1%) who were initiated on PA twice daily to achieve glycemic control. Of these, 56 patients (12.9%) were diagnosed as moderate COVID-19 and required corticosteroids. Among these, 42 patients (75%), on PA regimen reported post lunch and dinner glycemic spikes which necessitated additional pre-lunch dose of premix analogue. 36 patients with mild COVID-19, were continued on PA twice daily and doses were uptitrated based on the SMBG reports. The rest 378 (87%) mild COVID-19 cases, were managed by standard care approach for diabetes care, including oral drugs. The mean RBS at the first consultation at insulin initiation was 211 mg/dL (SD±98, 95% CI 192 to 230). On first follow up teleconsultation;mean RBS in mild COVID-19 was 178 mg/dL (SD±50, 95% CI 138 to 195), while those who progressed to moderate COVID-19, RBS was 267 mg/dL (SD±101, 95% CI 210 to 298). On second follow up;mean RBS in mild COVID-19 was 168 mg/dL (SD±54, 95% CI 148 to 183) and in moderate COVID-19 was 203 mg/dL (SD±88, 95% CI 174 to 258). 138 patients (31.7%) needed uptitration of insulin regimen Discussion/Conclusion: Simplified insulin regimen based on premix analog insulin has the potential for timely initiation of insulin, titration and intensification to third dose of PA to optimise the management of T2D in COVID-19. Our study did not account for the compliance to beyond the second teleconsultation and the pandemic prevented the estimation of A1C and did not account for patients who transformed as severe COVID-19 patients who needed hospitalisation