Guidance for the management of hyperglycaemia in virtual ward settings has been issued.
The Concise advice on Inpatient Diabetes (COVID:Diabetes) – Virtual Ward Guidance was led by Professor Gerry Rayman and the rest of the National Inpatient Diabetes COVID-19 Response Group.
This is the latest document that has been published by the group which was set up to support inpatient diabetes care during the COVID-19 pandemic.
The guidance covers the impact Dexamethasone and other glucocorticoids have on people who have diabetes and COVID-19. Hyperglycaemia is a common side effect of glucocorticoid treatment and COVID-19 infection itself has also been found to predispose to hyperglycaemia in those with and without a prior diagnosis of diabetes.
Hyperglycaemia has been associated with adverse outcomes in those with COVID-19 infection and so effective treatment is desirable.
The document was drafted to support safe management of hyperglycaemia in those receiving glucocorticoid treatment for COVID-19 infection outside of a hospital environment.
The guidance also covers oral glucose-lowering agents, glucose and ketone monitoring, HbA1c assessment and corrective insulin dosage.
It differs from previous guidance published by this group for the management of hyperglycaemia in those receiving glucocorticoid treatment in hospital in that the management is more pragmatic and less intensive to take into consideration the likelihood of reduced surveillance; thus for example minimum as well as ideal frequency of glucose monitoring are stated, lower doses of insulin are suggested to avoid hypoglycaemia and for simplicity once daily insulin is recommended.
Detailed guidance around the COVID virtual ward model is available from NHS England and the guidance recommends that services leading virtual COVID wards establish links with the local diabetes services to agree any necessary processes or pathways required to support this guidance.
To read the document, click here.