Objective
We share our experiences related to a Diabetes Care for Covid patients rendered over the last 11 months, by the Samatvam Endocrinology Diabetes Team, Bangalore, India. Unprecedented public health crisis forced the “Endocrinology Team” to serve also as General Physicians in providing and coordinating overall comprehensive “Covid 19 Infectious Disease Care” [out of sheer social need and humanitarian duty], even to people and families without Diabetes or other Endocrine disorders. The emphasis has been on prompt day to day acquisition and assimilation of global scientific data, often confusing/conflicting, and practically and effectively delivering the same to both “Providers” and “Patients” in need.
Methods
“Telemedicine [TM] Care and Creativity” included: (a) Remote diagnostic and therapeutic specialist guidance: to both in-hospital/ ICU physicians and nursing staff, as well as patients and family members in home care under isolation and quarantine; (b) Individual “serious / complicated” patient centric “Whats app groups” and “email chains”: for 24x7 data gathering, patient monitoring, therapy guidance and counselling, with both physician [clinic and hospitalist] and patient/ family participation and postings; (c) Tele-self-care technique trainings for “naïve/new/ untrained” patients under home care/quarantine [Eg: Glucose Monitoring, Insulin/GLP-1 and Heparin Injections, via archived or real time video demonstrations. These services have been provided to patients within Bangalore City and Karnataka State [urban and rural], and also from far off places within India and even few overseas [touching the lives of more than 1000 patients directly or indirectly]. Samatvam has implemented Covid Antibodies Sero-surveillance and is participating in the National Vaccination Program.
Results
In hospital Diabetes Care: Treatment Order Sheets for Doctors and Nurses on Duty: These included: Useful 'Front Door' guidance for individual patients [Eg: Discontinuation of SGLT-2 inhibitors and metformin in all patients on acute presentation; Urine ketone testings]; Diabetes Management Flow Charts: Scheduled Insulin / Medication Doses and Supplements; Special Protocols for: 1: People with no past history of Diabetes and no Stress Hyperglycaemia; 2: People with no past history of Diabetes and Stress Hyperglycaemia diagnosed in Hospital; 3: People with past history of Diabetes on Oral Diabetes Medicines OHA [+/- Insulin]; 4: Sick / ICU diabetes patients with severe hyperglycaemia, DKA or HHNK: 5: Intravenous Insulin; 6: Steroid – Glucocorticoid Therapy - Special precautions; 7. Potential Covid related benefits of DPP-4 inhibitors- immunomodulatory.
Discussion/Conclusion
Implementable and pragmatic guidance for health care providers [especially those unfamiliar with speciality diabetes care] caring for patients hospitalized for Covid-19 has been an imminent need. Diabetes care for Covid patients in home settings can also be challenging. Diabetes care must be synchronized with other complex Covid medical management as a way of minimizing risk for complications and death.