Glycemic control metrics assessed by flash glucose monitoring in an adults hospitalized with COVID-19

Abstract

Background: The use of in-hospital flash glucose monitoring (CGM) can facilitate medical decision.

Purpose: Describe the glycemic behavior in hospitalized patients with COVID-19 evaluated by CGM and to explore the association between in-hospital glycemic control and adverse outcomes. Additionally describe the security of the resistant correction scheme.

Methodology: Prospective cohort.

Results: 27 patients were included. Twenty-five had at least one adverse outcome. (25.9% ICU, 11.1% septic shock, 40.7% ARDS, 25.9% acute kidney injury, and 22.2% acute cardiac injury). Mean capillary glucose was 245 mg/dl, mean interstitial glucose 180 mg/dl, time in range (TIR) ??70-180 mg/dl 52.9%, time above time in range (TAR) >180 mg /dl 43.7%, below the time in range (TBR) <70 mg/dl 4.8% and the coefficient of variation (CV) 35.2%. The best discriminative capacity was for CV with an AUC of 0.70 (95% CI 0.45-0.94). In 11 patients, at least one correction was performed using the resistant scheme of the 2012 international guideline without inducing hypoglycemia. 69% achieved a goal measurement five hours later.

Conclusions: The CGM can facilitate the understanding of the relationship between glycemic control during hospitalization and adverse clinical outcomes. The coefficient of variation showed the best performance to predict clinical complications compared to the rest of the metrics. Glycemic control in patients receiving dexamethasone is challenging and requires an approach that includes not only basal and prandial insulin but also an appropriate correction regimen.