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Published on: June 11, 2012
Proposed guidelines for screening of hyperglycemia in patients hospitalized with COVID-19 in low resource settings
Alpesh Goyal1, Setu Gupta1, Yashdeep Gupta1
1Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
Insights
This study offers a practical guide for screening hyperglycemia in COVID-19 patients without known diabetes in low-resource settings. It proposes a blood glucose monitoring algorithm to identify and manage elevated glucose levels effectively.
Area of Science:
- Endocrinology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has highlighted diabetes as a critical comorbidity, worsening patient outcomes.
- Effective management of hyperglycemia in non-diabetic COVID-19 patients is crucial, especially in resource-limited healthcare settings.
Purpose of the Study:
- To develop a practical algorithm for screening hyperglycemia in hospitalized COVID-19 patients without a prior diabetes diagnosis.
- To provide guidance adaptable for low-resource settings with limited healthcare expertise.
Main Methods:
- A review of existing guidelines on hyperglycemia screening in COVID-19 patients.
- Development of a blood glucose monitoring algorithm using simple capillary blood glucose measurements.
- Proposal of specific thresholds for initiating further monitoring and pharmacotherapy.
Main Results:
- A proposed algorithm involves paired capillary blood glucose (BG) assessment (pre-meal and 2-h post-meal) for all hospitalized COVID-19 patients.
- Patients with BG levels below 7.8 mmol/L (pre-meal) and 10.0 mmol/L (post-meal) may not require further monitoring.
- Elevated BG values trigger 24-hour monitoring, with immediate pharmacotherapy for significant elevations (≥8.3 mmol/L pre-meal, ≥11.1 mmol/L post-meal) or dietary modifications for moderate elevations (7.8-8.3 mmol/L pre-meal, 10.0-11.1 mmol/L post-meal).
Conclusions:
- The study provides actionable strategies for screening and managing hyperglycemia in COVID-19 patients without known diabetes in low-resource environments.
- The proposed guidance is potentially applicable to broader clinical settings in the future.
Background And Aims:
The coronavirus disease 2019 (COVID-19) pandemic has immensely strained healthcare systems worldwide. Diabetes has emerged as a major comorbidity in a large proportion of patients infected with COVID-19 and is associated with poor health outcomes. We aim to provide a practical guidance on screening of hyperglycemia in persons without known diabetes in low resource settings.
Methods:
We reviewed the available guidelines on this subject and proposed an algorithm based on simple measures of blood glucose (BG) which can be implemented by healthcare workers with lesser expertise in low resource settings.
Results:
We propose that every hospitalized patient with COVID-19 infection undergo a paired capillary BG assessment (pre-meal and 2-h post-meal). Patients with pre-meal BG < 7.8 mmol/L (140 mg/dL) and post-meal BG < 10.0 mmol/L (180 mg/dL) may not merit further monitoring. On the other hand, those with one or more value above these thresholds should undergo capillary BG monitoring (pre-meals and 2 hours after dinner) for the next 24 hours. When two or more (≥50%) such values are significantly elevated [pre-meal ≥8.3 mmol/L (150 mg/dL) and post-meal ≥11.1 mmol/L (200 mg/dL)], pharmacotherapy should be immediately initiated. On the other hand, in patients with modest elevation of one or more values [pre-meal 7.8-8.3 mmol/L (140-150 mg/dL) and post-meal 10.0-11.1 mmol/L (180-200 mg/dL)], dietary modifications should be initiated and pharmacotherapy considered only if BG control remains suboptimal.
Conclusion:
We highlight strategies for screening of hyperglycemia in persons without known diabetes treated for COVID-19 infection in low resource settings. This guidance may well be applied to other settings in the near future.
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