Abstract Body

Covid-19 pandemic has been a new experience where physicians & scientists, experimented with already existing therapies & technologies in various permutations and combinations. Over the past 1 year, at least 20% of those experiments provided fruitful results worthy enough to fight a pandemic which is unlikely to settle soon. Our center in Kerala,South India, has been in the forefront of using technologies in diabetes- telemedicine(TM) and remote monitoring (Diabetes Tele Management System- DTMS^Ⓡ) since 1997. Recent advancements such as bluetooth enabled glucometers, Guardian Connect, Libre etc., were incorporated whenever indicated.

Since more than 20,000 of our patients were already familiar with TM before lockdown, we organized multiple Zoom webinars on advices on necessity to urgently reach customized treatment targets. Option for Virtual Covid IP was also provided to registered patients who contracted Covid. Virtual Covid IP involved dedicated WhatsApp groups with patient, family members and a team of 3 doctors, 4 nurses, 2 diabetes educators and 2 dietitians ensuring 24*7 care, every 2–3-hour remote monitoring of temperature, glucose, blood pressure, respiratory rate and pulse rate. Remote glucose monitoring with CGM was initiated if required with training via WhatsApp video.

Blood glucose has been now recommended as the fifth vital sign. The use of TM and remote monitoring for diabetes as well as for Covid has been found to result in 90.9% success with a substantial 85% adopting this technology post Covid when compared to 60% pre Covid. User friendly cost effective diabetes technolgies are under utilised in India. If Covid is facilitiating a transformation, it might save millions.

Background and Aims

Uncontrolled glycemia is recognised as a critical factor in prognosis of Covid-19. Hospitalised patients have several challenges in frequently monitoring glucose and adjusting dosages in addition to inevitable fear of PPE suits and impending death. Our patients are used to virtual consultations via DTMS^® which has been in vogue since 1997.

Methods

For consenting patients diagnosed of Covid-19, we offer 'virtual Covid IP care' with 24/7 support, care and advices from a team of 3 doctors, 4 nurses, 2 diabetes educators and 2 dietitians. Risk assessment is carried out online using a questionnaire and is assigned to the Virtual IP follow up team(VIT). The care is coordinated through a dedicated WhatsApp group of patient and caretaker where a doctor and nurse is assignd duty 24/7. The VIT follows up with the patient to assess parameters such as body temperature,BG, BP, SpO2 and general well-being every 3-6 hrs. The patient should have usual self-monitoring devices with them for remote monitoring. Various technologies such as Libre, Guardian Connect, Apple Watch,connected glucose meters etc. are used in selected patients. Sample collection for essential lab investigations(CBC,LFT,RFT,CRP,D-Dimer,Ferritin, LDH etc.) are arranged at home.

Results

127 diabetes patients affected with Covid-19 availed of the virtual IP facility. Virtually managing BG round the clock was the top priority. In patients on dexamethasone, CGM was made mandatory. 2 patients were hospitalised. All patients recovered.

Conclusions

With predictions of similar pandemics in future, virtual IP concept needs to be studied further and popularised to prevent overwhelming hospitals and inaccesibility to critical care.