Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

Diabetes Care. 2021 Apr;44(4):1055-1058. doi: 10.2337/dc20-2085. Epub 2021 Feb 9.

Abstract

Objective: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment and reduce potential exposures during coronavirus disease 2019 (COVID-19).

Research design and methods: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 intensive care unit.

Results: All nine patients required mechanical ventilation and corticosteroids. During the protocol, 75.7% of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients.

Conclusions: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • Blood Glucose / analysis*
  • Blood Glucose / metabolism
  • Blood Glucose Self-Monitoring / instrumentation
  • Blood Glucose Self-Monitoring / methods
  • COVID-19* / blood
  • COVID-19* / complications
  • COVID-19* / drug therapy
  • Critical Illness / therapy*
  • Diabetes Complications* / blood
  • Diabetes Complications* / drug therapy
  • Equipment and Supplies
  • Female
  • Humans
  • Insulin / administration & dosage*
  • Insulin Infusion Systems*
  • Intensive Care Units
  • Male
  • Middle Aged
  • Point-of-Care Systems
  • Proof of Concept Study
  • Remote Sensing Technology* / instrumentation
  • SARS-CoV-2

Substances

  • Blood Glucose
  • Insulin