Management of Diabetes after Hospitalization for COVID-Infection

ABSTRACT

COVID-infection and its treatment can markedly worsen hyperglycemia. Conversely, patients with diabetes who contract SARS CoV-2 are at increased risk of morbidity and mortality, and their management post-hospital stay can be challenging. The aim of this study was to describe a comprehensive and effective approach for monitoring and treating glucose levels in COVID-patients after hospitalization. Over a period of nine months, 37 patients (13 females and 24 males, average age 64 years) were treated, with 18 having a previously known history of diabetes. All patients received therapy with multiple daily injections of insulin and started on personal continuous glucose monitoring (CGM) for use at home. The patients were evaluated every 2-4 weeks via in-person and telehealth visits. During and in between these visits, the outpatient insulin regimen was adjusted by electronic portal communication and remote data upload via software and individual CGM accounts. Ten patients were on basal insulin, while 27 were on multiple daily insulin injections. At a mean follow-up of 4 months post-discharge, the average hemoglobin A1c decreased from 10.3% to 6.9%, an impressive change of 3.4% (p<0.05) . The average time-in-range (TIR) , a key metric used with CGM, increased from 53% at first post-hospital visit, to 74% at 4 months. In conclusion, patients requiring hospital care after being diagnosed with acute COVID-infection manifest with significant exacerbation of hyperglycemia, and in many cases, new-onset diabetes. Most patients require intensive insulin regimens for diabetes control, often in concert with CGM use;this approach can effectively lower A1c and TIR. It is imperative that patients be provided close follow-up and support by maintaining contact on an ongoing basis.