Last month, Endocrine News ran a feature about the need optimal glycemic control in patients hospitalized with COVID-19, which could require physicians treating these patients to take different approaches than usual. Now, an international group of healthcare experts have developed an app to help the providers on the front lines of caring for patients with diabetes who have been hospitalized with the novel coronavirus.
The app, called COVID-IN-DIABETES (Collaborative Open-Access Virtually Individualized Decision-Algorithms for Inpatient Diabetes — covidindiabetes.org) was developed with the goal of achieving glycemic control with a community-centered perspective, which means caring for patients while preserving personal protection equipment (PPE) and decreasing the spread of COVID-19. (The project is partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant number P30-DK-111024.)
Francisco J. Pasquel, MD, MPH, assistant professor of medicine in the Division of Endocrinology at Emory University in Atlanta, who developed the app and serves at its content editor, says that he and his colleagues had actually already been working on a project with the goal of individualizing therapy in the hospital, with recent experience they have gained in the inpatient setting and through knowledge gained through observational studies and clinical trials. “With COVID-19 there was actually an immediate need to learn how people was transforming care in the inpatient setting,” Pasquel says. “We observed changes in protocols, ways people are trying to be creative to care for patients and to protect our nurses and the community. So, along with Javier Szyszlican (developer) and Agustina Urrutia (post-doc fellow) we decided to target this as our first effort and see where it would take us.”
The site will have two main areas — Hospital Care and Diabetes Technology – and Pasquel and his team are still adapting this site to what they think people who use it might be interested in. Each section will have a repository to share protocols along with other experiences and knowledge, relevant literature, and a “news section.” “This initiative also represents our ‘response and mitigation’ efforts in a broader concept we are working on with colleagues from the Rollins School of Public Health, which consists on adapting the Preparedness Cycle framework to understand transformations in diabetes care during the COVID-19 pandemic,” Pasquel says.
An upcoming section will focus on telemedicine, as the pandemic has forced many physicians to stop seeing patients in the clinic and adopt new technologies. “We are collecting different experiences about the potential benefits of telemedicine and the gaps and barriers for optimal implementation,” Pasquel says. “I hope we can stimulate those discussions.”
Since releasing the app, Pasquel says they have received lots of feedback and interest from many investigators and physicians caring for patients with diabetes and COVID-19 in the U.S. and around the world. David Klonoff, MD, medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center in San Mateo, Calif. and editor-in-chief of Journal of Diabetes Science and Technology recently signed on as the project’s co-editor to help with the content. “[We’ve received] recommendations about including sections that may be of interest, suggestions on the most relevant topics, and opportunities/ideas for collaborations,” Pasquel says. “We are very excited about other colleagues joining so we can hopefully have a place where it will be easy to access relevant information related to the transformations in care related to the interaction of diabetes, COVID-19, and advances in technology.”
It’s well established that hyperglycemia in the hospital leads to poor outcomes, which makes patients with diabetes particularly vulnerable to the adverse effects of this virus. Pasquel says that there may be minor discrepancies on how care is delivered to achieve target glucose goals, but there is a general agreement supported by evidence around the importance of improving inpatient glycemic control.
“There is an opportunity to share what readers are experiencing during transformations in diabetes care,” Pasquel says. “Our small community is growing and we would like to invite everyone interested in participating in the discussion. In the section ‘Share Your Experience,’ providers taking care of patients with diabetes can join the conversation. We will post the results of our surveys in the same app.”