Study Aims To Solve Special Problem for COVID-19 Patients With Diabetes

As many as 20 percent of COVID-19 patients being treated in the intensive care unit may have diabetes, according to recent studies, making management of their glucose levels a vital concern.

Competing with this, however, is the need to minimize healthcare workers' contact with COVID-19 patients and conserve personal protective equipment. Every time a healthcare worker goes into a COVID-19 patient's room to get a glucose reading is another potential exposure, and it further depletes scarce personal protective equipment.

At UH, a study is getting under way to test a tactic to solve this problem. A team from the UH Division of Endocrinology and Metabolism is deploying to the ICU a tool that is typically used in outpatient settings -- the continuous glucose monitor (CGM). CGM systems take measurements at regular intervals, 24 hours a day, and translate the readings into dynamic data, generating glucose direction and rate of change.

Helping Patients and Health Care Workers

The study's goals are two-fold: To improve patients' glycemic control, and to use the CGM as a means to reduce COVID-19 patient contact with healthcare workers.

The UH team says they're optimistic that this approach will be effective.

"We believe that the use of real-time and retrospective data from continuous glucose monitoring can be utilized with inpatients/ ICU settings to increase time spent in target glycemic range," says Caitlin Omoregie, PA-C, the study's principal investigator. “We also think that access to this data can reduce the frequency of healthcare worker exposure to COVID- 19 patients without compromising glycemic control."

For the study, COVID-19 patients with diabetes in intensive care at UH Cleveland Medical Center, UH Ahuja Medical Center, UH Geauga Medical Center, a campus of UH Regional Hospitals and UH Portage Medical Center will be enrolled – 46 patients at main campus and 18 patients at each community hospital. To determine whether CGM monitoring in somehow different for COVID-19 patients than for other intensive care patients with diabetes, the team will also test the CGM approach with six diabetic patients from the Heart Failure Intensive Care Unit at UH Cleveland Medical Center.

As preparation for the study, teams are being trained via online lectures for remote viewing. These lectures are available several times each week so that involved team members may participate at their convenience, but before they use CGM device with a patient in their care. Participants complete quizzes and surveys after each lecture session.

Still Finger Sticks

To be clear: The use of the CGM device does not mean the intensive care patients will never get the traditional finger stick glucose check.

"The ICU nursing staff will additionally collect point-of-care finger glucose readings every four hours or as they are scheduled to enter the patient's room for standard of care in the ICU setting," Ms. Omoregie says.

In the end, the UH endocrinology team hopes to gather a wealth of data, on patients' glycemic control while wearing a CGM device and on any reduction in healthcare workers entering COVID-19 patients' intensive care unit rooms.

"We're very interested whether there is reduction in patient contact for exclusive purpose of glucose measurement/intervention," Ms. Omoregie says. "Stay tuned."

Related links

The University Hospitals Division of Clinical & Molecular Endocrinology provides a full range of treatments for Type 1 and Type 2 diabetes – with a strong emphasis on self-management. Learn more about diabetes treatment at University Hospitals.