In-patient management of hyperglycemia during COVID-19 pandemic

Abstract

The pandemic of COVID-19 has presented new challenges to endocrine physicians and diabetologists in providing care for infected patients with dysglycemia, who may already be having diabetes and who present with newly diagnosed diabetes. The additional burden of metabolic decompensation, effect of treatment on glycemia, and the presence of comorbid complications make the management challenging. The presence of diabetes as a comorbid condition has shown to be associated with poorer outcomes in patients with COVID-19 infection. In addition, the effects of treatments such as the use of medications such as glucocorticoids and hydroxychloroquine may further add to the variability in glycemic control. Appropriate glycemic management leads to improvement in clinical outcomes, which involves intensive bedside glucose monitoring, intravenous and subcutaneous insulin administration, transition from intravenous to subcutaneous insulin, as well as interventions for hypoglycemia events. A uniform treatment protocol related to insulin administration and glucose monitoring is essential for improved clinical outcomes in admitted patients. Where feasible, continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but they are not available everywhere and not many personnel are experienced in its usage. In-patient care of diabetes is an important issue that needs to be addressed if it is used in hospitalized patients.