An audit reviewing the implementation of guidelines from the National Inpatient Diabetes Covid-19 Response Group regarding blood glucose management and dexamethasone therapy in covid-19 patients using the MicroGuide app®

ABSTRACT

Aims: High-dose corticosteroids reduce mortality in covid- 19 patients requiring oxygen therapy. Dexamethasone-induced hyperglycaemia is a known complication and linked to increased morbidity and mortality. The National Inpatient Diabetes Covid-19 Response Group produced guidance on corticosteroid therapy in covid-19 patients (June 2020). We assessed using the MicroGuide app® to help implement this guidance. Methods: We audited patients that received Dexamethasone and supplemental oxygen for covid-19 during two admission peaks -Oct/ Nov 2020 and Jan/ Feb 2021 (sample n = 30). Along with education and diabetes team ward-rounds, between peaks our trust introduced a guideline summary using the Microguide® smartphone-app. Results: In Oct/Nov20, 15 had known diabetes vs. 15 patients not known to have diabetes;11 and 19 respectively in Jan/Feb21. Capillary blood glucose (CBG) checks carried out as per guidelines in 27% of patients Oct/Nov20 vs. 64% of patients in Jan/Feb21. 60% experienced CBG >12mmol/l at least once in Oct/Nov20, compared with 70% in Jan/Feb21. Diabetic emergencies (DKA/HHS) were ruled out by ketone/pH testing in 57% in Oct/Nov20, improving to 76% in Jan/Feb21 (all had U+E checked). Of the insulin naïve population who experienced hyperglycaemia (n = 15 both), 27% were commenced on intermediate acting insulin Oct/Nov20 compared to 60% in Jan/ Feb21. Conclusion: Most patients experienced hyperglycaemia during admission. CBG monitoring by nursing staff improved between peaks, as did ruling out emergencies. Commencing intermediate-acting insulin if hyperglycaemic, as recommended, improved too. We believe the MicroGuide® app improved these outcomes as training and education of staff was limited during this time period, and this offered remote digital and easy accessible guidance.