The Impact of COVID-19 on CGM Use in the Hospital.

Abstract

In 1995 the movie Outbreak was released, and we shivered but were amused. The fictional virus “Motaba” was soon replaced by the very real H1N1, severe acute respiratory syndrome coronavirus (SARS-CoV, which causes SARS), and Ebola. Fortunately, the overall devastation of these potential pandemics, with the concern of deaths in the thousands or millions, never materialized. However, now the world is faced with SARS-CoV-2, the virus known to cause coronavirus disease 2019 (COVID-19), and the 2020 “Outbreak” movie is not fictional. This virus is real, and we are racing to find ways to save lives from this deadly disease while protecting the health and well-being of frontline health care workers. There is now a strong body of evidence that diabetes, established cardiovascular disease, and other metabolic risk factors (particularly visceral fat accumulation) are associated with increased risk of need for mechanical ventilation, acute kidney injury, and mortality (1–4). Hyperglycemia during hospitalization for COVID-19 has also been established as a poor prognostic indicator (4,5). Some studies report that those with previously poorly controlled diabetes tend to have higher morbidity and mortality (4). However, another recent study found that previous insulin use, not HbA1c, was a predictor of mortality (6). More recently reported was that COVID-19 survivors had lower mean glucose during hospitalization than nonsurvivors (7). This finding brings some of the old controversy about glycemic management in the hospital to light, raising the question of whether lowering glycemic goals may help mitigate the acute on top of chronic inflammatory response and improve outcomes. A report in 2001 on critically ill surgical patients gained wide attention (8). Intensive insulin therapy in the intensive care unit (ICU) improved morbidity and mortality, and much of the diabetes world extrapolated these findings to all patients in all hospitals. Unfortunately, …