Preliminary observations of COVID-19 patients with diabetes inspired an algorithm for glucose monitoring that's suspected to help combat the virus' serious complications.
As COVID-19 continues to rage across the U.S., researchers are digging deeper into how the virus wreaks havoc on the body, especially for those with a pre-existing chronic illness.
Now, after preliminary observations of 200 COVID-19 patients with severe hyperglycemia, a Michigan Medicine team is shedding light in a new American Diabetes Association paper about why high blood sugar may trigger worse outcomes in people infected with the virus. And researchers have developed a blood sugar management tool that may potentially reduce risk of secondary infections, kidney issues and intensive care stays in people with diabetes, prediabetes or obesity who get COVID-19.
When the body becomes this inflamed, it triggers an abnormal immune response that instead of just attacking the virus, affects the rest of the body's healthy cells and tissue, leading to rapid deterioration in health. It is most likely the low grade, inflammatory nature of diabetes and hyperglycemia that promote the virus' inflammatory surge, resulting in insulin resistance and severe hyperglycemia.
Specifically, these patients are at an increased risk for mechanical ventilation, kidney replacement therapy due to kidney failure and requiring medications known as vasopressors to stop dangerously low blood pressure or steroids to combat acute respiratory distress syndrome.
The research team developed a tool to identify and manage high blood sugar in COVID-19 patients, placing them into certain risk categories that looked at hyperglycemia severity, presence of obesity, level of insulin resistance, extent of kidney dysfunction and evidence of rapid changes in inflammatory markers.
Implementing an algorithm
The newly created hyperglycemia management teams set out to find a way to monitor patients' diabetes without having to use more personal protective equipment to visit the rooms all the time. It was also important to reduce the health care provider's exposure to the virus as much as possible.
Although typically accurate, a continuous glucose monitor wouldn't be as helpful because a patient's low blood pressure and the use of blood pressure medications could falsely elevate blood sugar levels.
The new protocol called for insulin delivery every six hours, and at the same time a nurse would check in on the patient. Some patients who were on ventilators or receiving high doses of Vitamin C would get their arterial or venous blood sugar levels checked, replacing the need for the team's blood sugar check.
For those with the highest blood sugar levels and severe hyperglycemia, insulin infusions were an option for patients until their levels fell between a normal range.
The result of these efforts helped successfully lower blood sugar levels without increasing nurse contact or the overall burden on primary care teams and PPE usage.
It's important to note this algorithm wasn't developed as a result of a clinical trial, but is based solely on preliminary observations in the patients the team followed. A larger, randomized and controlled study is necessary to determine how this algorithm impacts mortality, time to recovery, the length of ICU stays and rate of severe complications.
The team is looking forward to the next steps in confirming the hypothesis. In the meantime, these observations validate the importance of blood sugar management in COVID-19 patients and can serve as a guide or inspiration for other institutions.