Abstract Body

The aim of the presentation is to explore the challenges of managing dysglycemia in the context of COVID-19 in hospitalized patients and how to achieve the best outcomes.

Diabetes and suboptimal glycemic control, amongst other characteristics, have been identified as risk factors for developing COVID-19 following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These risk factors are also associated with worse outcomes. Several mechanisms have been postulated.

Hyperglycemia and hypoglycemia during admission to hospital are associated with adverse hospital outcomes. There is a higher risk of dysglycemia in patients with COVID-19 with or without pre-existing diabetes. Many patients present to hospitals with diabetes emergencies (diabetic ketoacidosis (DKA) and/or hyperosmolar hyperglycemic state (HHS)). Hyperglycemia on admission with COVID-19 is associated with worse outcomes. Hyperglycemia in the context of COVID-19 is linked to longer hospitals stays, higher risk of developing acute respiratory distress syndrome, increased mortality compared to those who did not develop hyperglycemia. Severe hyperglycemia after admission was a strong predictor of death among patients not admitted to intensive care units. Critically unwell patients with diabetes and COVID-19 have high insulin requirements and poorer time in range at the time of the COVID-19 peak inflammatory response. There is a higher risk of stress hyperglycemia in patients with COVID-19 without a history of pre-existing diabetes.

Dexamethasone and other steroids (e.g. hydrocortisone, methylprednisolone, prednisolone) are being used to manage patients with COVID-19. Maintaining good blood glucose control during this time is essential to improve clinical outcomes. Several guidelines have been developed to improve time in range and prevent the development of diabetes emergencies during admissions to hospital.

There are studies emerging to support the use of flash and continuous glucose monitoring systems in addition to point of care testing to optimize inpatient glucose time in range and prevention of hypoglycemia and hyperglycemia.

Concerns were raised of shortages of infusion pumps as a results of hospitals being overwhelmed by cases of COVID-19. As a result, several guidelines were developed using subcutaneous regimen to manage diabetes emergencies (DKA/HHS) and persistent hyperglycaemia.

Following a phase of high insulin requirements at the peak of the COVID-19 inflammatory response, it is challenging to predict the drop in insulin requirements when there is a higher risk of hypoglycemia.

Our understanding of the management of COVID-19 and glucose control during hospital admissions continue to evolve with further studies and technologies.