ADA Develops New Blood Sugar Management Algorithm Which May
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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 ADA 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.

The newly created hyperglycemia management teams set out to find a way to monitor patients' diabetes without having to use more PPE 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.

"Improving blood sugar control was important in reducing the amount of secondary infections and kidney issues this cohort of patients are susceptible to," researchers say. "This might help shorten ICU stays and lessen the amount of patients that need a ventilator."

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.

Source: https://diabetes.diabetesjournals.org/content/early/2020/08/10/dbi20-0022
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