A clinical audit to assess the quality of glycaemic surveillance and treatment for hyperglycaemia in patients with and without diabetes receiving dexamethasone for covid-19 pneumonitis

ABSTRACT

Aims: To assess the quality of glycaemic surveillance and treatment of hyperglycaemia in patients with covid-19 treated with dexamethasone between a diabetic specialty ward (DW) and a respiratory ward (RW). Methods: 50 patients met inclusion criteria covid-19 positive, treated with dexamethasone, based on a DW or RW. Data collected during November 2021 included frequency of capillary blood glucose (CBG) and ketone monitoring and treatment of hyperglycaemia. Anonymised data was collated and analysed using Microsoft Excel. Results were assessed against NHS trust and national guidelines. Recommendations assessed • CBG monitoring four-times daily (QDS) on commencement of Dexamethasone • Ketone checks if CBG >12mmol/L • If two consecutive CBG readings >12mmol/L in 24 hours, start Humulin-I if insulin-naive or increase existing insulin dose. Results: CBG was checked QDS consistently in 16% of patients (26% DW, 4% RW). Ketones were not checked at all in 26% of patients who had at least one CBG reading of more than 12mmol/L (20% DW, 33% RW). 63% of patients who had two consecutive CBG readings of more than 12mmol/L were either started on Humulin-I or had their existing insulin dose increased (69% DW, 50% RW). Summary: Consistent glycaemic monitoring was seen in a minority of patients across both wards, with the DW achieving better results. These results reinforce the need for early involvement from the diabetes team and for improvement in education for non-diabetic speciality wards. Actions to be taken;present findings at departmental meeting, provide education for staff via posters, develop a hospital reminder system prompting QDS CBG monitoring when dexamethasone is prescribed.