Diabetes technology and COVID-19

Glucose monitoring technology has proved invaluable during the pandemic in allowing services to support people with type 1 diabetes remotely. The ability to upload technology directly to the Cloud is particularly valuable for real-time review of glucose control. Abbott donated 6500 FreeStyle Libre sensors to NHS diabetes services to facilitate safe and rapid discharge of insulin-treated people from hospital, which has been particularly valuable for people newly diagnosed with type 1 diabetes. The June edition of Diabetes, Technology & Therapeutics was devoted to the utility of technology in dealing with various impacts of the pandemic on diabetes care, and shows how technology has been used both to support those newly diagnosed and to prevent diabetic ketoacidosis.

In addition, there was a suggestion that the donated sensors could be used for contactless glucose monitoring for people with diabetes hospitalised with COVID-19 infection. Whilst this remains controversial due to uncertainty about accuracy in critically ill patients, a recent article by Ushigome et al (2020) reports on a Japanese patient with type 2 diabetes requiring intravenous insulin and COVID-19 pneumonia requiring mechanical ventilation. Use of a Dexcom G4 sensor allowed remote monitoring whilst maintaining effective glucose control and protected the health of those looking after the patient.

In the outpatient setting, remote clinics have become the norm as a result of the pandemic. Uploading of information through platforms such as Glooko-Diasend, LibreView, Dexcom Clarity and Medtronic Carelink is crucial in ensuring that remote clinics function efficiently and that consultations are meaningful to both parties – although care has to be taken not to allow data to dominate the conversation at the expense of a discussion about wider health issues and wellbeing. An online-first publication by Crossen et al (2020) includes a guide on how best to set up and make the most of these virtual consultations.

Analysing the data we can now access through glucose-sensing technologies not only is valuable on an individual basis but also gives an insight into how the population of people with diabetes is coping during the pandemic. The two papers summarised in this Digest, using continuous glucose data obtained from people with type 1 diabetes, show that, overall, lockdown has been associated with improved glycaemic control, as evidenced by increased time in range in Scottish and Spanish populations, with little change in hypoglycaemia risk.

The authors speculate as to the possible reasons why control improved. However, of concern is that, in the Scottish population, socioeconomic deprivation was associated with worsening of glycaemic control, as defined by an increase in estimated HbA_1c of ≥5 mmol/mol (0.5%). Mortality from COVID-19 infection in people with type 1 diabetes has been associated with both socioeconomic deprivation and poor glycaemic control (Holman et al, 2020). Given the concern that COVID-19 will continue to have a significant on population health for the foreseeable future, it will be important to increase our understanding of how we can better support those affected by socioeconomic deprivation with diabetes technology, in order to optimise their glucose control and reduce their risk of adverse outcome should they be infected with COVID-19.

Digests:

• Flash and continuous glucose monitoring reveals improvements in glycaemic control during lockdown
• ABCD audit demonstrates benefits of flash glucose monitoring in people with type 1 diabetes
• Hypoglycaemia is less common with CGM than SMBG despite achieving the same HbA_1c
• [Sponsored] Use of FreeStyle Libre in people with type 2 diabetes reduces HbA1c and hospitalisations

Crossen S, Raymond J, Neinstein A (2020) Top 10 tips for successfully implementing a diabetes telehealth program. Diabetes Technol Ther 21 Apr [epub ahead of print]. https://doi.org/10.1089/dia.2020.0042

Holman N, Knighton P, Kar P et al (2020) Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 13 Aug [epub ahead of print]. https://doi.org/10.1016/S2213-8587(20)30271-0

Ushigome E, Yamazaki M, Hamaguchi M et al (2020) Usefulness and safety of remote continuous glucose monitoring for a severe COVID-19 patient with diabetes. Diabetes Technol Ther 15 Jul (epub ahead of print]. https://doi.org/10.1089/dia.2020.0237