University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
University of Pittsburgh Medical Center Shadyside Hospital, Omaha, NE.
J Clin Endocrinol Metab. 2020 Sep 1;105(9). doi: 10.1210/clinem/dgaa342.
The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On-site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.
COVID-19 大流行给为感染糖尿病的患者提供护理的医院人员带来了新的挑战，这些患者占重症监护病房中危重症患者的 20%以上。适当的血糖管理有助于减少急性疾病的不良临床结局，但也需要对患者进行密集的互动，以进行床边血糖监测、静脉和皮下胰岛素给药，以及快速干预低血糖事件。这些任务是在建议尽量减少患者互动的时候需要完成的，这是避免医护人员长时间接触 COVID-19 的一种方式，因为他们经常在个人防护设备供应有限的环境中工作。本文的目的是为临床医生提供指导，在协调感染住院糖尿病患者的推荐护理标准的同时，应对该国许多地区医疗系统不堪重负的日常现实。讨论了修改后的胰岛素给药、床边血糖监测以及可能影响血糖控制的药物（如皮质类固醇和羟氯喹）的使用。连续血糖监测系统被提议作为减少与患者在一起时间的一种选择，但如果在住院患者中使用这些系统，需要解决一些重要问题。现场和远程血糖管理团队有可能在人员短缺且在住院患者血糖管理方面具有专业知识的地区提供指导。
