The rapid detection of postprandial hyperglycaemia (PPHG) is imperative for the diagnosis of diabetes and the assessment of health risks for nondiabetics. We also need to identify the types of people who are most likely to find FGM and CGM useful for self-management and for which populations they have the most benefit in terms of clinical outcomes and length of stay. We need evidence on which types of hospital wards might benefit from the introduction of this technology and the contexts in which they are less useful. More studies are required in which the feasibility, benefits and limitations of FGM and CGM in non–intensive care unit hospital settings are elucidated. In addition, people with diabetes may be empowered to better self-manage their condition in hospital as they have direct access to their glucose data. Rapid analysis of glucose measurements can facilitate clinical decision making and therapy adjustment in the hospital setting. Potential problems include lack of experience with this technology and costs of sensors. If used in the general ward hospital settings, CGM and flash glucose monitoring (FGM) systems could lead to improved glycemic control, decreased length of stay, and reduced risk of severe hypoglycemia or hyperglycemia. In particular, the feasibility of “flash” and continuous glucose monitoring (CGM) remains untested on general wards.
However, the implementation of these protocols is limited in practice. There are a wide range of guidelines published, which seek to ensure safe and effective inpatient glycemic control in the hospital setting. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.Įvidence indicates that poor glycemic control is associated with increased morbidity and length of stay in hospital. We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). Length of stay was not associated with any of the studied variables (all p-values >0.05). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay.ĭuring this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1 mean age: 70.6 years mean HbA1c: 68.2 mmol/mol mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19.
People with diabetes are at high risk of severe COVID-19 with poor outcomes. COVID-19 placed significant challenges on healthcare systems.
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