Remote continuous glucose monitoring with a computerized insulin infusion protocol for critically ill patients in a COVID-19 medical ICU: Proof of concept
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Abstract
OBJECTIVE: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment and reduce potential exposures during coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 intensive care unit. RESULTS: All nine patients required mechanical ventilation and corticosteroids. During the protocol, 75.7% of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70–180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients. CONCLUSIONS: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.
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CGM studies in inpatients with steroid-induced hyperglycemia or posttransplant diabetes on daily steroids show that fasting glucose can be in range while hyperglycemia is mostly detected in the afternoon and evening.
“For inpatients with steroid-induced hyperglycemia or with posttransplant diabetes receiving daily steroids, CGM studies have demonstrated that while fasting glucose could be within range, hyperglycemia is mostly detected in the afternoon and evening.1386”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1386]
The Results (page unavailable) describe CGM use in nine critically ill patients with type 2 diabetes and COVID-19 who received steroids, but do not report fasting glucose or an afternoon–evening pattern. Searches for posttransplant diabetes and diurnal steroid-related hyperglycemia found no passage addressing the claimed pattern. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThis approach was taken to reduce PPE use and more closely monitor patients so health care personnel do not have to enter a patient room solely to measure glucose.
“This approach has been taken to reduce the use of personal protective equipment and more closely monitor patients so that health care personnel do not have to go into a patient room solely to measure a glucose level (283-286).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [283]
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Self-citationAlley Baggett - Attrice straniera foto immagine
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Self-citation
- Authors
- Davis, G. M., Faulds, E., Walker, T., Vigliotti, D., Rabinovich, M., Hester, J., Peng, L., McLean, B., Hannon, P., Poindexter, N., Saunders, P., Perez-Guzman, C., Tekwani, S. S., Martin, G. S., Umpierrez, G., Agarwal, S., Dungan, K., & Pasquel, F. J.
- Affiliations
- Emory University (US)
- The Ohio State University (US)
- Grady Health System (US)
- Morehouse School of Medicine (US)
- Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, GA
- Albert Einstein College of Medicine (US)
- Corresponding author
- Pasquel, Francisco J.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-02-09
- Volume
- 44
- Issue
- 4
- Pages
- 1055-1058
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC7985417
- OpenAlex
- W3126263986
- Cited by
- 94
- References
- 17
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 16 · 2023: 19 · 2022: 26 · 2021: 10
- FWCI
- 13.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- continuous glucose monitoring, remote glucose monitoring, COVID-19 pandemic, critically ill patients, intensive care unit, point-of-care glucose testing, sensor accuracy, mechanical ventilation, corticosteroids, time in range, diabetes management, electronic health record integration, decision support system
- MeSH terms
- Proof of Concept Study, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Aged, Aged, 80 and over, Algorithms, Blood Glucose, Equipment and Supplies, Female, Humans, Insulin, Insulin Infusion Systems, Intensive Care Units, Male, Middle Aged, Blood Glucose Self-Monitoring, Critical Illness, Point-of-Care Systems, Diabetes Complications, Remote Sensing Technology
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