Adherence to 'covid:diabetes' guidance improved management of blood glucose in patients with covid-19 respiratory disease treated with dexamethasone

ABSTRACT

Background and Aims: Dexamethasone has been widely used in the management of covid-19 respiratory disease after the RECOVERY (Randomised Evaluation of covid-19 Therapy) trial showed improved outcomes. We conducted a double loop audit in order to improve our practice according to the Diabetes UK guidance for the management of hospitalised patients with covid-19 respiratory disease who received dexamethasone therapy. Methods: The data was collected consecutively for adult hospitalised patients with covid-19 infection proven on PCR or on high clinical suspicion. Patients on prior maintenance steroids and those admitted to the Intensive care were excluded. The patients were identified via hospital management system and data was collected from clinical notes and drug charts. We collected 56 patients' data in the first cycle and 41 patients in the second cycle. Evaluation was focussed on correct blood glucose monitoring, insulin dose administration and glycaemic complications. First cycle results were shared with the teams followed by a period of education using leaflets and easy to read posters. Results: Adherence to guidance improved from 48.2% to 92.7% between the two audit cycles. Correct dose of insulin was given in 41% cases initially which improved to 100% after teams' education. No glycaemic complications were noted after teams' education as compared to one hypoglycaemia event in the first cycle. Diabetes Specialist Team's input was less frequently (15%) sought after teams education as compared to 44.4% in the first cycle. Conclusion: Better adherence to the 'coviddiabetes' guidance improved the management of blood glucose in covid-19 respiratory disease treated with Dexamethasone. This saves healthcare resources and improves inpatient care.