A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic
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- Mary Korytkowski
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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- Kellie Antinori-Lent
- University of Pittsburgh Medical Center Shadyside Hospital, Omaha, NE
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- Andjela Drincic
- University of Nebraska Medical Center, Omaha, NE
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- Irl B Hirsch
- University of Washington, Seattle, WA
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- Marie E McDonnell
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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- Robert Rushakoff
- University of California, San Francisco, California
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- Ranganath Muniyappa
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
抄録
<jats:title>Abstract</jats:title> <jats:p>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.</jats:p>
収録刊行物
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- The Journal of Clinical Endocrinology & Metabolism
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The Journal of Clinical Endocrinology & Metabolism 105 (9), 3076-3087, 2020-06-04
The Endocrine Society