Endocrine Abstracts

Dexamethasone reduces mortality in COVID patients who require oxygen therapy. Dexamethasone-related hyperglycaemia however is a known complication. Capillary blood glucose (CBGs) above 10.0 mmol/l have been linked to increased mortality in COVID patients. Approximately a third of COVID patients with dexamethasone-related hyperglycaemia may develop diabetes later. It is therefore important to manage acute episodes of hyperglycaemia effectively and identify these patients for follow-up in the community. Diabetes UK COVID-19 guidelines recommend at least once daily CBG monitoring for non-diabetics and at least 4 times daily monitoring for diabetics. When managing acute dexamethasone-related hyperglycaemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) should be excluded before commencing subcutaneous rapid-acting insulin therapy. The audit analysed management of acute hyperglycaemia in COVID patients on dexamethasone therapy in a central London hospital during the COVID pandemic from 1/1/2021 to 19/3/2021. The main analyses included (1) appropriate intervals of CBG monitoring, (2) ruling out of DKA/HHS, and (3) if the correct dose of rapid-acting insulin was given in accordance to Diabetes UK COVID-19 guidelines. A total of 65 encounters of hyperglycaemia were identified, with the highest CBG during admission analysed. Our results showed that 9.2% did not have their CBGs monitored at appropriate intervals (at least OD for non-diabetics, QDS for diabetics). Moreover, 67.7% did not rule out DKA/HHS when their CBGs were >12 mmol/l , one of which had CBG >30 mmol/l (no documentations or tests to rule out HHS/DKA). Only one encounter had the correct dose of insulin administered in accordance with Diabetes UK guidance; 57% had no insulin given. A teaching presentation was done with the foundation doctors to highlight the results and the importance of identifying and managing COVID patients with hyperglycaemia. In addition, we are currently in the process of developing a trust-standardised EPIC smart-phrase for foundation doctors, especially for out-of-hours.