COLUMBUS, Ohio – At the start of the COVID-19 pandemic when the nation went into lockdown, medical intensive care nurses and diabetes nurse practitioners partnered with a multi-disciplinary team at The Ohio State University Wexner Medical Center to develop a new way to care for COVID-19 patients with high blood sugar.
This innovation, which allows MICU nurses to safely and effectively monitor glucose and administer insulin from outside the rooms of COVID-19 patients, recently earned the University Hospital and Ross Heart Hospital at Ohio State Wexner Medical Center the 2021 ANCC Magnet Prize from the American Nurses Credentialing Center (ANCC). The prize honors innovative nursing programs and practices within ANCC Magnet recognized organizations.
“It is truly a testament to our profession that despite the challenges we all face with the COVID-19 pandemic, we are able to remain resilient and create innovative solutions to enhance the care for our patients,” said Jacalyn Buck, chief nursing officer at Ohio State Wexner Medical Center. “This groundbreaking innovation designed by my team has made a lasting impact on the care for COVID-19 patients with hyperglycemia and will continue to improve care for many more.”
Current clinical practice requires nurses to perform hourly fingerstick blood sugar checks for patients with diabetes. These frequent trips into the patient’s room require the use of personal protective equipment to prevent exposure to COVID-19.
The MICU and diabetes team created a hybrid glucose monitoring protocol for COVID-19 patients with diabetes. The protocol incorporated continuous glucose monitoring technology that traditionally isn’t used in hospitals. The hybrid system allows nurses to monitor patients and dispense insulin from outside the patient room, limiting their risk of exposure and conserving personal protective equipment.
“Millions of people with diabetes use continuous glucose monitors to check their blood sugar throughout the day in lieu of fingersticks,” said Eileen Faulds, assistant professor at The Ohio State University College of Nursing and diabetes nurse practitioner at Ohio State Wexner Medical Center. “Our inpatient diabetes management team saw an opportunity to use the same technology to transform how we care for our patients.”
The nursing team created a program to teach every MICU nurse to apply, assess and maintain continuous glucose monitoring as the standard of care for their COVID-19 patients with prediabetes and diabetes who develop hyperglycemia. They have been able to reduce the frequency of bedside testing by 71% for more than 100 critically ill COVID-19 patients. The protocol developed at Ohio State is now being used in dozens of health systems across the country.
Nurses at Ohio State are conducting a multi-site retrospective study with other health systems that have implemented the protocol. Additionally, they plan to conduct research on the use of the protocol in non-COVID-19 patients.
Insulin is as essential as water for many people with diabetes. Of the more than 30 million Americans with diabetes, approximately 7.4 million rely on insulin to manage their condition. But it is one of the most costly drugs on the market, and the COVID-19 pandemic has intensified the already rampant problem of insulin hoarding or rationing.
Not only is diabetes associated with an increased risk of severe COVID-19 infection, but COVID-19 is also associated with both an increase in new diabetes diagnoses and a worsening of preexisting diabetes complications. By September 2021, death rates for people with diabetes were 50% higher than before the pandemic, a net increase of more than twice the overall death rate of the general population.
I am a pharmacist who studies ways to improve clinical, economic and quality-of-life outcomes in vulnerable populations. My recent study on how insulin prescription rates have changed because of the pandemic underscores the challenges that people with diabetes face in accessing care.
Managing diabetes during a pandemic
Although insulin is a vital component of diabetes management, the pandemic has led many patients to forgo the prescriptions they need.
My recent study looked at the insulin prescription claims of 285,343 people in the U.S. between January 2019 and October 2020. In the first week of 2019, there was an average of 17,037 new and existing insulin prescriptions picked up by patients per week. This number increased by 11 claims each week leading up to the pandemic.
By the first week of the pandemic in March 2020, however, insulin prescriptions decreased significantly by an average of around 396 prescriptions. Prescriptions continued to decrease an average of around 55 per week as the pandemic progressed through to October 2020. This decline may result from a combination of health insurance loss owing to unemployment, restricted access to clinicians and pharmacies and rationing or stockpiling of medications by both pharmacists and patients.
And the effects of the pandemic on diabetes go beyond just insulin prescriptions. Diabetes management involves visits with a variety of health care providers and routine testing. But diabetes patients in the U.S. had a significant drop in usage of health care services in 2020 compared with 2019, because of clinic closures and reduced capacities, health insurance loss and transportation difficulties. Patients are left in a bind, risking potentially life-threatening complications from missing needed diabetes care as well as risking exposure to COVID-19 if they need emergency care for those complications.
Ongoing effects of care delays
As COVID-19 overwhelmed health care systems, people with chronic conditions like diabetes have experienced significant disruptions in routine and emergency medical care. By the end of June 2020, an estimated 41% of U.S. adults had delayed or avoided medical care.
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Even now, with hospitals crowded with unvaccinated COVID-19 patients, nearly 1 in 5 American households had to delay care for serious illnesses in the past few months. These care delays have the potential to worsen chronic conditions and contribute to excess deaths directly and indirectly caused by COVID-19.
The full effect that the COVID-19 pandemic continues to have on diabetes management and care, however, has yet to be fully understood. More research on how the pandemic has affected people with diabetes is needed to ensure that these patients receive the care that they need.
