Diabetes and COVID-19

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CGM inpatient

  • 1.  CGM inpatient

    Posted 04-09-2020 17:39
    I am looking into using CGM in hospitalized COVID patients .. I am trying to first see if feasible to get devices . I would exclude hypotensive patients or those on pressors
    Potentially. a hybrid model of using POC BG and CGM
    Would be very interested in any protocols other hospitals have
    Currently my estimation is less than 10 patients a week may need this . I reached out to dexcom for more information

    Rundsarah Tahboub FACE

  • 2.  RE: CGM inpatient

    Posted 04-10-2020 12:50
    Abbott announce a partnership with the ADA yesterday
    ABBOTT PARK, Ill., April 8, 2020 /PRNewswire/ -- Abbott (NYSE: ABT) announced today that the FreeStyle Libre 14 day system, the world's leading3 continuous glucose monitoring (CGM) technology, can now be used in the hospital setting2 during the COVID-19 pandemic, according to the U.S. Food and Drug Administration (FDA). This will permit frontline healthcare workers to remotely monitor patients with diabetes receiving inpatient care by assessing real-time glucose levels4 and glucose history. To help hospitals and medical centers in COVID-19 outbreak hotspots ramp up access to the technology, Abbott will donate 25,000 FreeStyle Libre 14 day sensors in partnership with the American Diabetes Association (ADA), Insulin for Life USA and Diabetes Disaster Response Coalition.

    Joseph Aloi

  • 3.  RE: CGM inpatient

    Posted 04-11-2020 17:48
    I hope someone/ ADA might consider helping some of the Indian Health service areas that have been hit hard by COVID with these resources as diabetes incidence is high in these tribal communities. Thanks for considering.

    M carol Greenlee DMSC, MD

  • 4.  RE: CGM inpatient

    Posted 04-12-2020 12:35
    Base upon the WSJ article on Friday, research presented by Randy Cron, MD, UAB, that the proliferation of macrophages and cytokine levels are causing escalation of the mortality associated with Covid-19 I am offering up a possible solution to slow the mortality rate:

    Based upon your analysis of the problem leading to mortality with patients infected with the Covid-19 virus , the proliferation of macrophages then subsequently leading to overwhelming production of Cytokines, I believe that I could share with you possible therapeutic interventions that would slow or resolve at least that portion of the issue that causes rapid decline in the patients status leading to mortality. 

    As you know the inflammatory cascade ( previously described in AHA journal and NLA journals in the early 2000's) is caused by the stimulation of both PPAR-alpha and PPAR-gamma in the body. 

    PPAR alpha stimulation leads to enhanced production of macrophages and then the macrophages then produce elevations in Cytokines which can also be attributed to elevated production of Free Fatty Acids/Triglycerides. PPAR-gamma stimulation can lead to an increase in c-IMT. 

    Two medications can inhibit these proliferation events that , as you suggest can cause cardiovascular collapse. 

    To block the PPAR alpha , the medication Fenofibrate( Tricor, Trilipix-Abbott)  is used. This is available in multiple strengths ranging from 48 mg to 160 mg , dosage of one tablet daily. It is available in both immediate release or sustained release product. The drug was designed to both lower triglycerides and elevate HDL. 

    To block the PPAR gamma response, the medication known as Pioglitazone ( Actos-Takeda), comes from the class of the thiazolidinedione-type , or sometimes referred to as TZD's. This medication will lower c-IMT. It is dosed safely in 15-30 mg tablets as an immediate release product. It is however contra indicated for use in patients with CHF.
    The medication has the indication for insulin resistance in diabetes patients, as an oral anti-diabetic treatment. 

    I would suspect that if patients upon admission were given a lipid panel, I would estimate that you would see elevations in the triglyceride levels and if post mortem's were performed looking at c-IMT, you would observe an abnormal level of thickening in the carotid intima media.

    Allen Nichol, Pharm.D., FAPhA
    COO/VP Clinical Operations CeutiCare Inc.
    2014 APhA  Daniel B. Smith Award Recipient
    614 506 8128

  • 5.  RE: CGM inpatient

    Posted 04-12-2020 14:27
    Join my webinar on very latest Medicare Covid19 waivers for DSMT + MNT on APRIL 15, 3 - 5 EST. Lots of time for QA! Register at www.dietitiancentral.com

    Take care, Mary Ann


    Mary Ann Hodorowicz Consulting, LLC

    RD, MBA, CDCES, 

    Certified Endocrinology Coder

    Cell: 708-359-3864

    Fax: 866-869-6279



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