Use Of Continuous Glucose Monitor In Critically Ill Covid-19 Patients Requiring Insulin Infusion: An Observational Study

Context: The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU).Objective: To evaluate feasibility and patient safety of a hybrid monitoring strategy of point-of-care (POC) BG plus continuous glucose monitor (CGM) in the ICU.Design: Retrospective analysis.Setting: ICU of an academic medical center.Patients: Patients with COVID-19 on IV insulin.Intervention: After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed.Main Outcome Measures: Outcomes included frequency of POC BG, workflow, safety, and accuracy measures.Results: The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter (71% reduction compared with standard of 24/day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70 to 180 mg/dL was 64 23% on day 1 and 72 +/- 16% on days 2 through 7, whereas time <70 mg/dL was 1.5 +/- 4.1% on day 1 and <1% on days 2 through 7.Conclusions: This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.