AI Algorithm for Blood Sugar Management Reduces Risk of Serious Complications in Diabetic COVID-19 Patients

Preliminary observations of COVID-19 patients with diabetes has inspired researchers from the University of Michigan (Ann Arbor, MI, USA) to develop an algorithm for glucose monitoring that could help combat the virus’ serious complications.

After preliminary observations of 200 COVID-19 patients with severe hyperglycemia, the Michigan Medicine team has discovered why high blood sugar may trigger worse outcomes in people infected with the virus. The researchers have also developed a blood sugar management tool that could potentially reduce the risk of secondary infections, kidney issues and intensive care stays in people with diabetes, prediabetes or obesity who get COVID-19.

According to the researchers, the low grade, inflammatory nature of diabetes and hyperglycemia promotes the virus’ inflammatory surge, resulting in insulin resistance and severe hyperglycemia. Specifically, these patients are at an increased risk for mechanical ventilation, kidney replacement therapy due to kidney failure and requiring medications known as vasopressors to stop dangerously low blood pressure or steroids to combat acute respiratory distress syndrome.
Based on their findings, the research team has developed a tool to identify and manage high blood sugar in COVID-19 patients, placing them into certain risk categories that looked at hyperglycemia severity, presence of obesity, level of insulin resistance, extent of kidney dysfunction and evidence of rapid changes in inflammatory markers. The newly created hyperglycemia management teams set out to find a way to monitor patients’ diabetes without having to use more personal protective equipment to visit the rooms all the time. It also aims 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,” said first author Roma Gianchandani, M.D., a professor of internal medicine in the Michigan Medicine division of metabolism, endocrinology and diabetes. “This might help shorten ICU stays and lessen the amount of patients that need a ventilator.”

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