COVID-19 Awakens a New Focus on Surge Capacity Blood Glucose Testing and the Critical Role of Telehealth in Self-Management

We have learned in recent weeks that the world was not prepared for the surge in COVID-19 testing due to the rapid spread of this novel virus. Although the Spanish influenza pandemic was more than a century ago, significant advancements in technology, care pathways, communication, and social networking were not enough to yield a coordinated global strategy. Attempting to appropriately scale the response system during the pandemic led to a crippling shortage of vital resources in the world’s leading healthcare systems.

Diabetes has been shown to be among the most common comorbidities in patients infected with COVID-19.¹ Evidence of a connection between metabolic control and this viral disease has emerged as an important consideration.² The Chinese Center for Disease Control and Prevention recently published the overall case fatality rate of COVID-19 at 2.3%—but among patients with pre-existing comorbid conditions such as diabetes, it jumped to 7.3%.³ Data from other coronaviruses and influenza consistently demonstrate that increased glycemic variability in patients with or without diabetes results in poorer outcomes.^4,5

Good glucose control has been a critical factor in COVID-19 mitigation and management, as it could be instrumental in reducing the severity of infection control. Laboratorians and clinicians have been vigilant in use of instruments to measure blood glucose in infected patients. Likely due to a lack or limited availability of protective personal equipment, we have seen an increased interest in continuous glucose monitors and Point of Care Testing. As a result of concern among laboratorians about the accuracy of these devices in the critically ill population, there has been an increase in requests for dedicated instruments for use in isolated patients. Disinfection and cleaning of multipatient use meters occurred with unvalidated methods such as alcohol wipes and exposure to ultraviolet light when on-label supplies were exhausted. As hospitalized COVID-19 patients with diabetes continue to consume a greater share of the testing resources, some institutions are looking toward the use of wearable electronic glucose monitors to limit staff contact and potentially reduce infection transmission.

Another way to mitigate the risk of infection spread and better enable providers to tend to the sickest patients, people with diabetes either not infected or without severe symptoms have been asked to avoid healthcare facilities, putting a sharp focus on self-management. Telemedicine technology for patient consultations has emerged as an increasingly valuable resource.

We are actively preparing for a future in which the integration of digital technologies into the nursing and clinician workflows will dramatically improve the coordination among healthcare providers and consolidate relevant data for people with diabetes, both in- and outpatient, into meaningful actions. Laboratories and their oversight of point-of-care diabetes testing services will have an increased capability to harness data and apply sophisticated algorithms for clinical decision support. Together with telemedicine, these advancements will produce more effective care models for all patients, including those in isolation in the event of the next health crisis.

Investing in our global public health infrastructure, surge capacity and data solutions are key to effectively control outbreaks that have had such a devastating impact on all patients, including those with diabetes, as well as healthcare systems and our economies. Being able to manage resources required at peak surge capacity remains our greatest challenge. Additionally, more work needs to be done with respect to sample collection strategies, including performing self-collection reliably in the safety of a patient’s home. New technology to improve the flow of information among countries, healthcare networks, and providers needs to be seamless and integrated into the care pathways.