COVID-19 and diabetes

Diabetes UK position statement

Diabetes UK has published a position statement¹ from the UK National Diabetes Inpatient COVID Response Group, which was formed at the end of March 2020. It outlines the need to maintain key elements of specialist diabetes services with a focus on delivering safe inpatient diabetes care.

It also provides simple pathways for the management of inpatients with diabetes by admitting teams in secondary care; as clinicians and trainees without diabetes expertise are delivering diabetes care during the COVID-19 pandemic.

To date the group, comprising UK‐based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines, which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists, and NHS England.

Care home guidance

A Diabetes UK position statement for the management of diabetes in care homes during the pandemic has also been published.² Written by the National Diabetes Stakeholders COVID-19 Response Group, it is aimed at supporting the special needs of residents with diabetes in care homes during the COVID-19 pandemic.

Aimed at care home managers, other care home staff, and specialist and non-specialist community nursing teams, the interim guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. It also outlines the conditions where hospital admission is required.

Reference

Rayman G, Lumb A, Kennon B et al. Guidelines for the management of diabetes services and patients during the COVID‐19 pandemic. Diabet Med 2020; published online 04 May 2020. https://doi.org/10.1111/dme.14316
Sinclair A, Dhatariya K, Burr O et al. Guidelines for the management of diabetes in care homes during the COVID-19 pandemic. Diabet Med 2020; published online 05 May 2020. https://doi.org/10.1111/dme.14317

COVID-19 diagnostic glucose/lactate sensor in development

The SMASH device which can measure glucose and lactate levels

Technology used in a wearable monitoring device for diabetes may be able help in the diagnosis of COVID-19. The Swedish company, Innovosens AB, who developed the diabetes device, is exploring investigations which indicate that this technology could be applied to monitor lactate levels in sweat, which may play a role in the diagnosis of COVID-19 and other viral infections.

They have developed a wearable device (SMASH – Sweat Metabolite Analysis for Sports and Health) that integrates a sensor to measure the body’s blood sugar and lactate levels from the skin without piercing the skin (see photo).

Studies have previously detected there are elevated levels of lactate in the body in patients suffering from lung infections, one of the most serious consequences of coronavirus infection. The sensor developed by Innovosens can be used to monitor lactate levels continuously, so that deviations in the values could provide an indication of infection at an early stage. When combined with other vital parameters, such as temperature, blood oxygen levels and heart rate / ECG metrics, the ability to indicate possible infections using a sensor linked to the wearable device and app becomes a real possibility.

They are collaborating with Dr Bruce D Johnson (Professor of Medicine and Physiology, Mayo Clinic, Rochester, USA). According to Dr Johnson, extensive research data suggest that elevated lactate levels in patients reflect more severe inflammatory conditions and hypoxic conditions.

“Lactate levels are usually assessed in the arterial or venous blood and can change rapidly,” he explained. “Having a potential sensor that assesses lactate in the sweat – in a predictable relationship with blood values – and that measures values in real time may not only help determine when infected patients are deteriorating, but also help guide treatment approaches and prognosis.”