Improving Glycemic Control in Patients With COVID-19 : A Quality Improvement Project

Abstract

Abstract Background Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. Reports have shown that diabetes is common among patients hospitalized in the United Kingdom with COVID-19 illness. Despite a preponderance of evidence that diabetes is associated with poor COVID-19 outcomes, there is a paucity of information on inpatient glycemic control among patients with diabetes and acute hyperglycemia hospitalized with COVID-19. Aim This quality improvement project was conducted to evaluate the current practice of glycemic management in hospitalized COVID patients and improve the glycemic control in these patients. Method 2 PDSA cycles were conducted with inability to continue further due to reduction in incidence of disease. This involved data collection regarding glycemic control in COVID-19 patients with diabetes on wards, focusing on the referral to DSN(Diabetes Specialist Nurses) , monitoring of blood glucose levels, management in case blood glucose levels were out of range. Data was also collected about the characteristics of patients. Results First PDSA showed that although in most cases, there were timely referrals to DSN in many cases, the monitoring and management of glycemic excursions was suboptimal in all cases. Blood glucose monitoring was also variable. In the second PDSA cycle, awareness sessions were conducted around glycemic management among medical and nursing staff. A two page document based on local guidance and recommendations of Association of British Clinical Diabetologists was prepared, and posted in the ward. It was also discussed in the handovers for wards. Results are shown in attached graph. Discussion In conclusion, awareness exercise and provision of guideline summary led to some improvement in glycemic control of these patients. Further PDSA cycles could not be done due to decrease in number of admissions.