Remote Continuous Glucose Monitoring during the COVID-19 Pandemic

1. Remote Continuous Glucose Monitoring during
the COVID-19 Pandemic

Remote Continuous Glucose Monitoring during the COVID-19 Pandemic
Continuous glucose monitoring automatically tracks blood glucose levels, throughout the day and night that enables people to review their change in glucose level over a few days to see trends and make changes in lifestyle accordingly. A study was done to explore the feasibility of using CGM in noncritically ill patients hospitalized with COVID-19 in the USA.

      There were 9 subjects for the study (4 male, mean [SD] age 52.6 [15.1] years) with HbA1c 12.0% (2.8%). The study was conducted for a mean 4.3 days. Dexcom sensor was placed in the lower abdomen of the patients and an iPhone 5S was used as receiver. The data received were transmitted to smart devices of the nurses and investigator. Based on this, the clinical team decided on the glycemic management that the patients should receive. An observation time of 24hrs were given, after which if the sensor and POC values correlated well, the frequency of POC glucose testing was reduced from four times to twice daily. Additional POC glucose was performed only when it was indicated clinically.

      The median (interquartile range) POC tests/day was 3 (2, 4). Mean (SD) POC glucose were 218.8 (71.1) mg/dL. Mean Sensor values were 219.3 (51.7) mg/dL, respectively. Mean absolute relative difference (MARD) was 9.77%, and 84.8% of the sensor values were in Clarke zone A and 100% were in zone A or B.

      CGM readings prompted five clinical interventions due to high or low glucose values (by alarm and trend glucose). There were no sensor-related adverse events. It was learnt that the acceptance by nursing staff and communication with the multidisciplinary team was essential. This pilot data support the use of CGM in non-critically ill patients. Future improvements should incorporate a true telemetry system with alarms, with direct data incorporation into medical records.

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