Researchers from the University of Michigan have developed an algorithm to help treat COVID-19 patients with diabetes.

The tool, according to the researchers could reduce the risk of complications, such as acute renal failure.

In the study published in the journal Diabetes, the researchers said within the very first days of COVID-19 in-patient surge, a phenotype of severe hyperglycemia was noted in a large proportion of the critically ill admitted patients carrying a prior diagnosis of type 1 diabetes, type 2 diabetes, prediabetes, or severe obesity.

The authors led by Roma Gianchandani noted that the patients’ glucose management was further complicated by rapid acute renal failure, tube feed initiation, vasopressor support for hypotension, steroids for acute respiratory distress syndrome, and chronic renal replacement therapy.

“Thus, our major aim was to develop viable algorithms to provide a targeted approach to managing hyperglycemia in COVID-19–infected patients based on a personalized risk stratification that includes different levels of hyperglycemia and insulin resistance, prior diabetes control, presence of obesity, needs and type of nutritional support, renal dysfunction, vasopressor support, and disease activity.

The algorithm provides the treatment guidelines for people without a prior diabetes diagnosis and those with known diabetes.

For critically-ill patients with severe hyperglycemia, it recommends administering an insulin infusion to lower blood glucose before transitioning to subcutaneous insulin.

The authors say these efforts helped them effectively manage patients’ blood glucose levels without increasing the level of contact from nurses or other healthcare professionals.

The authors said scheduled regular insulin, a sliding scale, and basal insulin adequately timed with other nursing interventions, especially arterial blood gas checks for ventilator settings, helped successfully lower glucose levels into goal range without increasing nurse contact, thus decreasing the overall burden and PPE use.

“Our algorithms to predict labile glucose values with significant hyper- and hypoglycemia were improved by monitoring the changes in inflammatory biomarkers levels checked by the intensive care unit teams, thus allowing us to prompt up or down titrations of insulin doses more confidently to prevent either further glucose surges or hypoglycemia.

“Given that insulin resistance reduces dramatically as a patient’s clinical condition improves, we proactively reduced insulin doses as soon as reductions in inflammatory biomarkers trends were documented.

“This flexible approach following trends in frequently monitored inflammatory markers to help us guide insulin titrations was a critical part of our evaluation. Our observations and developed algorithms were in fact in concordance with the recent publication by Hamdy and Gabbay outlining a similar experience and administration of regular insulin every 6 h in the management of diabetes in COVID-19 patients in ICU at the Joslin Diabetes Center.

“In addition, similar to our Perspective, the recent review by Al-Jaghbeer and Lansang provides broad guidance in the management of hyperglycemia in COVID-19 patients in ICU,” they said.

The authors added that improving glucose control is a critical measure to improve outcomes and reduce secondary infections, renal dysfunction, and therefore ICU stay and ventilator dependence.

“There is adequate precedence from prior ICU data about similar associations of glycemic control with patient morbidity and survival. We believe that sharing our rapidly accumulated experience in adjusting insulin regimens to maintain appropriate glucose levels in conjunction with the following trends in inflammatory markers could guide glycemic management for other institutions.

“In the meanwhile, evaluation of our glucose management strategies and their impact on outcomes on COVID-19 patients with hyperglycemia is in process,” the submitted.

PUNCH HealthWise