Type 1 diabetes and technology at time of COVID-19: A case report.,European Journal of Clinical Investigation

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Type 1 diabetes and technology at time of COVID-19: A case report.
European Journal of Clinical Investigation ( IF 5.5 ) Pub Date : 2020-05-22 , DOI: 10.1111/eci.13290
Renzo Cordera ₁ , Cristina Pinducciu ₁ , Davide Maggi ₁

Affiliation

Intermittent acute illness contributes to blood glucose dysregulation in Patients with type 1 diabetes mellitus (T1DM): systemic inflammation, insulin resistance, unpredictable eating, fever, nausea, and vomiting, among other factors lead to blood glucose instability with a significant risk of hypoglycaemia and represent a difficult challenge for Patients.1 Hyperglycaemia (with or without diabetes) is a double‐edged sword: is depend on the acute illness and by itself negatively contribute to a more severe prognosis. A stable blood glucose concentration below 10 mmol/L is the recommended target and a clinical priority in hospitalized Patients. In this setting, insulin therapy is mandatory but not easy to carry‐on and it requires an expert clinical team. Devices to facilitate insulin therapy are now available: Minimed 670G (Medtronic) is the most sophisticated commercially available insulin infusion system that controls blood glucose in an independent way from Patient intervention: it requires only accurate CHO counting and few safety dictated glucose reading for calibration.2 This system is based on algorithm able to forecast time ahead blood glucose concentration and to calculate the insulin infusion amount and speed in order to keep glucose concentration in a safety range. This technology is changing protocols of insulin therapy and might allow a more accurate glucose control expressed as “time in range.” However, experience with Minimed 670G has been mainly reported in Patients with T1DM in stable conditions and less is known on glucose control by Minimed 670G in heavy stress conditions, such as serious infective intercurrent diseases.

COVID‐19 is a recent pandemic disease due to infection with SARS‐CoV‐2 virus, whose clinical course can be very serious.3 In observational trials on COVID‐19, hyperglycaemia and diabetes are associated with a negative prognosis.4 Here, we describe the successful glucose control obtained by MINIMED 670G in a Patient with T1DM and COVID‐19.

The Patient is a female, with long‐standing T1DM complicated by acropathy and nonproliferative retinopathy. For years, her blood glucose control has been at the best suboptimal. In the last 7 months, she started to use MINIMED 670G to infuse insulin. Working as a hospital‐based radiologist, she was infected by SARS‐CoV‐2 virus. Her clinical course was characterized by high fever >39.5C° for 5 days, vomiting, extreme fatigue and dyspnoea. She also reported strange smell and taste. Since before the beginning of COVID‐19 her glucose control was optimal, we together with the Patient decided to continue insulin therapy by Minimed 670G, in spite of the lack of specific indications.

Figure 1 shows glycaemic trend and time in range (TIR) observed in the 5 days of high fever (>39.5°C) and constitutive symptoms. Data are presented as the mean hourly glucose concentration and time in range (shaded area). It is evident that even in the worst condition Minimed 670G maintained excellent and stable glucose control. (reporting of this study conforms to broad EQUATOR guidelines). This case is paradigmatic and instructive: Minimed 670G has shown to control blood glucose also in stress situation. When confirmed by other experiences, automated glucose control should be offered to all Patients with T1DM as the best available insulin therapy, not only looking at “time in control” but also at glucose response to stress events. This last point might dramatically change quality of life of people with T1DM also during intercurrent disease and stress.

**FIGURE 1**
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Blood glucose recording in the days with higher fever. The dotted line shows the mean hourly glucose value during the worst five days while the shaded area indicates glucose concentration stability. The green column (at the left) represents “Time in Range” in the same days

ACKNOWLEDGEMENT

Authors thank Francesca Gulotta for her advice in editing the figure.

CONFLICT OF INTEREST

The author declare no conflict of interest.

REFERENCES

中文翻译：

COVID-19 时的 1 型糖尿病和技术：病例报告。

间歇性急性疾病导致 1 型糖尿病 (T1DM) 患者的血糖失调：全身炎症、胰岛素抵抗、不可预知的进食、发烧、恶心和呕吐等因素导致血糖不稳定，并有显着的低血糖和对患者来说是一项艰巨的挑战。1高血糖（伴有或不伴有糖尿病）是一把双刃剑：取决于急性疾病，本身对更严重的预后产生负面影响。稳定的血糖浓度低于 10 mmol/L 是住院患者的推荐目标和临床优先事项。在这种情况下，胰岛素治疗是强制性的，但并不容易进行，并且需要专业的临床团队。现在可以使用促进胰岛素治疗的设备：Minimed 670G (Medtronic) 是最先进的商用胰岛素输注系统，它以独立于患者干预的方式控制血糖：它只需要准确的 CHO 计数和很少的安全指示的葡萄糖读数来校准。2该系统基于能够提前预测血糖浓度并计算胰岛素输注量和速度以将葡萄糖浓度保持在安全范围内的算法。这项技术正在改变胰岛素治疗方案，并可能实现更准确的血糖控制，以“范围内的时间”表示。然而，使用 Minimed 670G 的经验主要报道在病情稳定的 T1DM 患者中，而对于 Minimed 670G 在重压力条件下（例如严重的感染性并发疾病）的血糖控制知之甚少。

COVID-19 是最近因感染 SARS-CoV-2 病毒而引起的大流行性疾病，其临床病程可能非常严重。3在 COVID-19 的观察性试验中，高血糖和糖尿病与不良预后相关。4在这里，我们描述了 MINIMED 670G 在一名患有 T1DM 和 COVID-19 的患者中获得的成功血糖控制。

患者为女性，长期患有 T1DM，并发肢端病变和非增殖性视网膜病变。多年来，她的血糖控制一直处于最佳状态。在过去的 7 个月里，她开始使用 MINIMED 670G 注入胰岛素。作为医院的放射科医生，她感染了 SARS-CoV-2 病毒。她的临床过程以高烧>39.5°C°持续5天、呕吐、极度疲劳和呼吸困难为特征。她还报告了奇怪的气味和味道。由于在 COVID-19 开始之前她的血糖控制是最佳的，我们与患者一起决定继续使用 Minimed 670G 进行胰岛素治疗，尽管缺乏具体的适应症。

图 1 显示了在高烧 (>39.5°C) 和体质症状的 5 天中观察到的血糖趋势和范围时间 (TIR)。数据表示为平均每小时葡萄糖浓度和范围内的时间（阴影区域）。很明显，即使在最坏的条件下，Minimed 670G 也能保持出色而稳定的血糖控制。（本研究报告符合广泛的 EQUATOR 指南）。这个案例具有典型性和指导性：Minimed 670G 已显示在压力情况下也能控制血糖。当其他经验证实时，应向所有 T1DM 患者提供自动血糖控制作为最佳可用的胰岛素治疗，不仅关注“控制时间”，还关注葡萄糖对压力事件的反应。