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Thabit H, Schofield J. Technology in the management of diabetes in hospitalised adults. Diabetologia 2024; 67:2114-2128. [PMID: 38953925 PMCID: PMC11447115 DOI: 10.1007/s00125-024-06206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
Suboptimal glycaemic management in hospitals has been associated with adverse clinical outcomes and increased financial costs to healthcare systems. Despite the availability of guidelines for inpatient glycaemic management, implementation remains challenging because of the increasing workload of clinical staff and rising prevalence of diabetes. The development of novel and innovative technologies that support the clinical workflow and address the unmet need for effective and safe inpatient diabetes care delivery is still needed. There is robust evidence that the use of diabetes technology such as continuous glucose monitoring and closed-loop insulin delivery can improve glycaemic management in outpatient settings; however, relatively little is known of its potential benefits and application in inpatient diabetes management. Emerging data from clinical studies show that diabetes technologies such as integrated clinical decision support systems can potentially mediate safer and more efficient inpatient diabetes care, while continuous glucose sensors and closed-loop systems show early promise in improving inpatient glycaemic management. This review aims to provide an overview of current evidence related to diabetes technology use in non-critical care adult inpatient settings. We highlight existing barriers that may hinder or delay implementation, as well as strategies and opportunities to facilitate the clinical readiness of inpatient diabetes technology in the future.
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Affiliation(s)
- Hood Thabit
- Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Jonathan Schofield
- Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Wang Y, Lu J, Wang M, Ni J, Yu J, Wang S, Wu L, Lu W, Zhu W, Guo J, Yu X, Bao Y, Zhou J. Real-time continuous glucose monitoring-guided glucose management in inpatients with diabetes receiving short-term continuous subcutaneous insulin infusion: a randomized clinical trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101067. [PMID: 39119238 PMCID: PMC11305887 DOI: 10.1016/j.lanwpc.2024.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 08/10/2024]
Abstract
Background The use of real-time continuous glucose monitoring (rtCGM) technology remains largely investigational in the hospital setting. The current study aimed to evaluate the effectiveness of rtCGM in inpatients with diabetes who were treated with short-term continuous subcutaneous insulin infusion (CSII). Methods In this randomized, parallel controlled trial conducted on the endocrinology wards in a tertiary hospital located in Shanghai, adults with type 1 and type 2 diabetes who required short-term CSII during hospitalization were randomly assigned (1:1) to receive either rtCGM-based glucose monitoring and management program or point-of-care (POC) standard of care (8 times/day) with blinded CGM. Primary outcome measure was the difference in the percentage of time within the target glucose range of 3.9-10 mmol/L (TIR, %). This study was registered at www.chictr.org.cn (ChiCTR2300068933). Findings Among the 475 randomized participants (237 in the rtCGM group and 238 in the POC group), the mean age of was 60 ± 13 years, and the mean baseline glycated hemoglobin level was 9.4 ± 1.8%. The CGM-recorded mean TIR was 71.1 ± 15.8% in the rtCGM group and 62.9 ± 18.9% in the POC group, with a mean difference of 8.2% (95% confidence interval [CI]: 5.1-11.4%, P < 0.001). The mean time above range >10 mmol/L was significantly lower in the rtCGM group than in the POC group (28.3 ± 15.8% vs. 36.6 ± 19.0%, P < 0.001), whereas there was no significant between-group difference in the time below range <3.9 mmol/L (P = 0.11). Moreover, the time to reach target glucose was significantly shorter in the rtCGM group than in the POC group (2.0 [1.0-4.0] days vs. 4.0 [2.0-5.0] days, P < 0.001). There were no serious adverse events in both groups. Interpretation In patients with diabetes who received short-term CSII during hospitalization, the rtCGM program resulted in better glucose control than the POC standard of care, without increasing the risk of hypoglycemia. Funding The Program of Shanghai Academic Research Leader (22XD1402300), Shanghai Oriental Talent Program (Youth Project) (No. NA), the Shanghai "Rising Stars of Medical Talent" Youth Development Program-Outstanding Youth Medical Talents (SHWSRS(2021)_099), and the Shanghai Research Center for Endocrine and Metabolic Diseases (2022ZZ01002).
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Affiliation(s)
- Yaxin Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Ming Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Jiaying Ni
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Jiamin Yu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Shiyun Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Liang Wu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Jingyi Guo
- Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Xiangtian Yu
- Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, China
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Bann SA, Hercus JC, Atkins P, Alkhairy A, Loyal JP, Sekhon M, Thompson DJ. Accuracy of a Continuous Glucose Monitor in the Intensive Care Unit: A Proposed Accuracy Standard and Calibration Protocol for Inpatient Use. Diabetes Technol Ther 2024. [PMID: 38913325 DOI: 10.1089/dia.2024.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background and Aims: Guidelines now recommend inpatient continuous glucose monitor (CGM) use with confirmatory blood glucose measurements. However, the Food and Drug Administration has not yet officially approved CGM for inpatient use in large part because its accuracy has not been established in this setting. We tested the accuracy of the Dexcom G6 (G6) in 28 adults on an insulin infusion in a medical-surgical intensive care unit with 1064 matched CGM and arterial point-of-care pairs. Methods: The participants were on average 57.29 (SD 2.39) years, of whom 13 had a prior diagnosis of diabetes and 14 were admitted for a surgical diagnosis. The first 19 participants received the G6 without calibration and had a mean absolute relative difference (MARD) of 13.19% (IQR 5.11, 19.03) across 659 matched pairs, which just meets the critical care expert recommendation of MARD <14%. We then aimed to improve accuracy for the subsequent 9 participants using a calibration protocol. Results: The MARD for calibrated participants was 9.65% (3.03, 13.33), significantly lower than for uncalibrated participants (P < 0.001). Calibration also demonstrated excellent safety with 100% of values within the Clarke Error Grid zones A and B compared with 99.07% without calibration. Our protocol achieved the lowest MARD and safest CEG profile in the critical care setting and well exceeds the critical care expert recommendations. Our large sample of heterogenous critically ill patients also reached comparable accuracy to the MARD of 9% for G6 in outpatients. We believe our calibration protocol will allow G6 to be used with sufficient accuracy in inpatients.
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Affiliation(s)
- Sewon A Bann
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Jess C Hercus
- Department of Biological Sciences, Simon Fraser University, Burnaby, Canada
| | - Paul Atkins
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Areej Alkhairy
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Jackson P Loyal
- Deanery of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Mypinder Sekhon
- Division of Critical Care, University of British Columbia, Vancouver, Canada
| | - David J Thompson
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
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Baker M, Lauterwasser S, Valenti C, Kallenberger M, Stolte H. Evaluation of a hybrid protocol using continuous glucose monitoring and point-of-care testing in non-critically ill patients in a community hospital. Am J Health Syst Pharm 2024; 81:e261-e267. [PMID: 38146957 DOI: 10.1093/ajhp/zxad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Inpatient glycemic management typically involves use of point-of-care (POC) glucose measurements to inform insulin dosing decisions. This study evaluated a hybrid monitoring protocol using real-time continuous glucose monitoring (rtCGM) supplemented with POC testing at a community hospital. METHODS Adult inpatients receiving POC glucose testing were monitored using rtCGM in a telemetry unit. The hybrid monitoring protocol required a once-daily POC test but otherwise primarily relied on rtCGM values for insulin dosing decisions. Outcomes assessment included surveillance error grid (SEG) and Clarke Error Grid (CEG) analysis results, the mean absolute relative difference (MARD) for available rtCGM-POC value pairs before and after study protocol application, the number of POC tests avoided, and the number of hypoglycemic events involving a blood glucose value of <70 mg/dL identified by rtCGM and POC values. RESULTS Data were collected from 30 inpatients (the mean age was 69.4 years, 77% were female, 80% had type 2 diabetes, and 37% were at-home insulin users). With the protocol applied, a total of 202 rtCGM-POC pairs produced a MARD of 12.5%. SEG analysis showed 2 pairs in the "moderate" risk category, with all other pairs in the "none" or "slight" risk categories. CEG analysis showed 99% of paired values to be in the clinically acceptable range. Six hypoglycemic events in 5 patients were resolved without incident. Three hundred three POC tests were avoided, a 60% reduction for the study duration. CONCLUSION Use of a hybrid monitoring protocol of rtCGM and POC testing in a community hospital demonstrated sustained rtCGM accuracy and was found to reduce the frequency of POC testing to manage inpatient glycemia.
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Affiliation(s)
- Matt Baker
- North Kansas City Hospital, North Kansas City, MO, USA
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Spanakis EK, Cook CB, Kulasa K, Aloi JA, Bally L, Davis G, Dungan KM, Galindo RJ, Mendez CE, Pasquel FJ, Shah VN, Umpierrez GE, Aaron RE, Tian T, Yeung AM, Huang J, Klonoff DC. A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials. J Diabetes Sci Technol 2023; 17:1527-1552. [PMID: 37592726 PMCID: PMC10658683 DOI: 10.1177/19322968231191104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Diabetes Technology Society organized an expert consensus panel to develop metrics for research in the use of continuous glucose monitors (CGMs) in a hospital setting. The experts met virtually in small groups both before and after an April 13, 2023 virtual meeting of the entire panel. The goal of the panel was to develop consensus definitions in anticipation of greater use of CGMs in hospital settings in the future. Establishment of consensus definitions of inpatient analytical metrics will be easier to compare outcomes between studies. Panelists defined terms related to 10 dimensions of measurements related to the use of CGMs including (1) hospital hypoglycemia, (2) hospital hyperglycemia, (3) hospital time in range, (4) hospital glycemic variability, (5) hospital glycemia risk index, (6) accuracy of CGM devices and reference methods for CGMs in the hospital, (7) meaningful time blocks for hospital glycemic goals, (8) hospital CGM data sufficiency, (9) using CGM data for insulin dosing, and (10) miscellaneous factors. The panelists voted on 51 proposed recommendations. Based on the panel vote, 51 recommendations were classified as either strong (43) or mild (8). Additional research is needed on CGM performance in the hospital. This consensus report is intended to support that type of research intended to improve outcomes for hospitalized people with diabetes.
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Affiliation(s)
- Elias K. Spanakis
- Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kristen Kulasa
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joseph A. Aloi
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georgia Davis
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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6
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Irace C, Coluzzi S, Di Cianni G, Forte E, Landi F, Rizzo MR, Sesti G, Succurro E, Consoli A. Continuous glucose monitoring (CGM) in a non-Icu hospital setting: The patient's journey. Nutr Metab Cardiovasc Dis 2023; 33:2107-2118. [PMID: 37574433 DOI: 10.1016/j.numecd.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
AIMS Although consistent data support the outpatient use of continuous glucose monitoring (CGM) to improve glycemic control and reduce hypoglycemic burden, and clinical outcomes, there are limited data regarding its use in the hospital setting, particularly in the non-intensive care unit (non-ICU) setting. The emerging use of CGM in the non-critical care setting may be useful in increasing the efficiency of hospital care and reducing the length of stay for patients with diabetes while improving glycemic control. DATA SYNTHESIS The purpose of this Expert Opinion paper was to evaluate the state of the art and provide a practical model of how CGM can be implemented in the hospital. SETTING A patient's CGM journey from admission to the ward to the application of the sensor, from patient education on the device during hospitalization until discharge of the patient to maintain remote control. CONCLUSIONS This practical approach for the implementation and management of CGM in patients with diabetes admitted to non-ICUs could guide hospitals in their diabetes management initiatives using CGM, helping to identify patients most likely to benefit and suggesting how this technology can be implemented to maximize clinical benefits.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Sara Coluzzi
- Endocrinology and Metabolism Unit, ASL, Pescara, Italy
| | - Graziano Di Cianni
- ASL Tuscany Northwest, Diabetes and Metabolic Disease, Livorno Hospital, Livorno, Italy
| | | | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Agostino Consoli
- Endocrinology and Metabolism Unit, ASL, Pescara, Italy; Department of Medicine and Aging Sciences DMSI and Center for Advanced Studies and Technology CAST, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
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7
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Zelada H, Perez-Guzman MC, Chernavvsky DR, Galindo RJ. Continuous glucose monitoring for inpatient diabetes management: an update on current evidence and practice. Endocr Connect 2023; 12:e230180. [PMID: 37578799 PMCID: PMC10563639 DOI: 10.1530/ec-23-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/14/2023] [Indexed: 08/15/2023]
Abstract
Over the last few years, several exciting changes in continuous glucose monitoring (CGM) technology have expanded its use and made CGM the standard of care for patients with type 1 and type 2 diabetes using insulin therapy. Consequently, hospitals started to notice increased use of these devices in their hospitalized patients. Furthermore during the coronavirus disease 2019 (COVID) pandemic, there was a critical need for innovative approaches to glycemic monitoring, and several hospitals started to implement CGM protocols in their daily practice. Subsequently, a plethora of studies have demonstrated the efficacy and safety of CGM use in the hospital, leading to clinical practice guideline recommendations. Several studies have also suggested that CGM has the potential to become the standard of care for some hospitalized patients, overcoming the limitations of current capillary glucose testing. Albeit, there is a need for more studies and particularly regulatory approval. In this review, we provide a historical overview of the evolution of glycemic monitoring in the hospital and review the current evidence, implementation protocols, and guidance for the use of CGM in hospitalized patients.
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Affiliation(s)
- Henry Zelada
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | - Daniel R Chernavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Rodolfo J Galindo
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine. Miami, Florida, USA
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Espinoza J, Xu NY, Nguyen KT, Klonoff DC. The Need for Data Standards and Implementation Policies to Integrate CGM Data into the Electronic Health Record. J Diabetes Sci Technol 2023; 17:495-502. [PMID: 34802286 PMCID: PMC10012359 DOI: 10.1177/19322968211058148] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The current lack of continuous glucose monitor (CGM) data integration into the electronic health record (EHR) is holding back the use of this wearable technology for patient-generated health data (PGHD). This failure to integrate with other healthcare data inside the EHR disrupts workflows, removes the data from critical patient context, and overall makes the CGM data less useful than it might otherwise be. Many healthcare organizations (HCOs) are either struggling with or delaying designing and implementing CGM data integrations. In this article, the current status of CGM integration is reviewed, goals for integration are proposed, and a consensus plan to engage key stakeholders to facilitate integration is presented.
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Affiliation(s)
- Juan Espinoza
- Division of General Pediatrics,
Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA,
USA
- Juan Espinoza, MD, FAAP, Division of
General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles,
University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA 90027,
USA.
| | - Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
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9
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Mader JK, Brix JM, Aberer F, Vonbank A, Resl M, Hochfellner DA, Ress C, Pieber TR, Stechemesser L, Sourij H. [Hospital diabetes management (Update 2023)]. Wien Klin Wochenschr 2023; 135:242-255. [PMID: 37101046 PMCID: PMC10133359 DOI: 10.1007/s00508-023-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral/injectable antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.
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Affiliation(s)
- Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Johanna M Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Alexander Vonbank
- Innere Medizin I mit Kardiologie, Angiologie, Endokrinologie, Diabetologie und Intensivmedizin, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Daniel A Hochfellner
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Claudia Ress
- Innere Medizin, Department I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Thomas R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
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10
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Avari P, Lumb A, Flanagan D, Rayman G, Misra S, Dhatariya K, Choudhary P. Continuous Glucose Monitoring Within Hospital: A Scoping Review and Summary of Guidelines From the Joint British Diabetes Societies for Inpatient Care. J Diabetes Sci Technol 2022; 17:611-624. [PMID: 36444418 DOI: 10.1177/19322968221137338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Increasing numbers of people, particularly with type 1 diabetes (T1D), are using wearable technologies. That is, continuous subcutaneous insulin infusion (CSII) pumps, continuous glucose monitoring (CGM) systems, and hybrid closed-loop systems, which combine both these elements. Given over a quarter of all people admitted to hospital have diabetes, there is a need for clinical guidelines for when people using them are admitted to hospital. The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) provide a scoping review and summary of guidelines on the use of diabetes technology in people with diabetes admitted to hospital.JBDS-IP advocates enabling people who can self-manage and use their own diabetes technology to continue doing so as they would do out of hospital. Whilst people with diabetes are recommended to achieve a target of 70% time within range (3.9-10.0 mmol/L [70-180 mg/dL]), this can be very difficult to achieve whilst unwell. We therefore recommend targeting hypoglycemia prevention as a priority, keeping time below 3.9 mmol/L (70 mg/dL) at < 1%, being aware of looming hypoglycemia if glucose is between 4.0 and 5.9 mmol/L (72-106 mg/dL), and consider intervening, particularly if there is a downward CGM trend arrow.Health care organizations need clear local policies and guidance to support individuals using diabetes technologies, and ensure the relevant workforce is capable and skilled enough to ensure their safe use within the hospital setting. The current set of guidelines is divided into two parts. Part 1, which follows below, outlines the guidance for use of CGM in hospital. The second part outlines guidance for use of CSII and hybrid closed-loop in hospital.
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Affiliation(s)
- Parizad Avari
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Daniel Flanagan
- Department of Endocrinology, University Hospital Plymouth, Plymouth, UK
| | - Gerry Rayman
- Ipswich Diabetes Centre, East Suffolk and North East Essex Foundation Trust, Ipswich, UK
| | - Shivani Misra
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
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11
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Longo RR, Joshi R. The Devil Is in the Details: Use, Limitations, and Implementation of Continuous Glucose Monitoring in the Inpatient Setting. Diabetes Spectr 2022; 35:405-419. [PMID: 36561647 PMCID: PMC9668728 DOI: 10.2337/dsi22-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Until recently, continuous glucose monitoring (CGM) systems were reserved for use in the outpatient setting or for investigational purposes in hospitalized patients. However, during the coronavirus disease 2019 pandemic, use of CGM in the inpatient setting has grown rapidly. This review outlines important details related to the accuracy, limitations, and implementation of, as well as necessary staff education for, inpatient CGM use and offers a glimpse into the future of CGM in the inpatient setting.
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Affiliation(s)
- Rebecca Rick Longo
- Lahey Hospital and Medical Center–Beth Israel Lahey Health, Burlington, MA
| | - Renu Joshi
- University of Pittsburgh Medical Center, Harrisburg, PA
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„Time in range“ (TIR) vs. Glykohämoglobin Typ A 1c (HbA 1c): was zählt für unsere Patienten? DIE DIABETOLOGIE 2022. [PMCID: PMC9552744 DOI: 10.1007/s11428-022-00963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
„Continuous glucose monitoring systems“ (CGM-Systeme) und CGM-basierte Metrik gewannen in den letzten 10 Jahren massiv an Bedeutung. Dennoch ist der HbA1c nach wie vor der meistverwendete und international anerkannte Marker zur Beurteilung der glykämischen Kontrolle. Ebenso stellt er in klinischen Studien immer noch den wichtigsten Surrogatparameter zur Beurteilung klinischer Outcomes dar. Die Verwendung der Zeit im Zielbereich („time in range“ [TIR]) hat im Vergleich zum HbA1c den Vorteil, dass Hypoglykämien und Glukosevariabilität besser dargestellt werden. Durch Nutzung der TIR kann man auch individuelle Zielbereiche definieren, beispielsweise bei Schwangeren oder multimorbiden Personen. Auch gibt es erste Hinweise, dass klinische Studienergebnisse anhand von TIR und anderen CGM-basierten Metriken bewertet werden können, auch wenn hierzu noch Langzeit- und Endpunktstudien fehlen. Einen wesentlichen Vorteil zeigt die TIR bei der Prädiktion diabetesassoziierter Komplikationen. So kann, basierend auf Änderungen beim erreichten Zielbereich, nicht nur das Auftreten neuropathischer, mikro- oder makrovaskulärer Komplikationen vorhergesagt werden, sondern auch das relative Risiko deren Manifestation. Die Nutzung von CGM im Allgemeinen und das Erreichen der TIR-Ziele spielen auch für Menschen mit Diabetes mellitus und deren Einschätzung ihrer Lebensqualität eine immer größere Rolle.
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Gothong C, Singh LG, Satyarengga M, Spanakis EK. Continuous glucose monitoring in the hospital: an update in the era of COVID-19. Curr Opin Endocrinol Diabetes Obes 2022; 29:1-9. [PMID: 34845159 PMCID: PMC8711300 DOI: 10.1097/med.0000000000000693] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Continuous glucose monitoring (CGM) systems are Food and Drug Administration approved devices for the ambulatory setting; however, they remain investigational systems for inpatient use. This review summarizes the most recent and relevant literature on the use of continuous glucose monitoring in the hospital setting. RECENT FINDINGS CGM provides real-time glucose data that enable healthcare professionals to make proactive and timelier clinical decisions with regards to diabetes management. CGM devices appear to be safe and accurate systems for glucose monitoring in the hospital setting. Real-time CGM systems and glucose telemetry can decrease hypoglycemia and reduce hyperglycemia in hospitalized patients with diabetes. Remote glucose monitoring decreases the need of frequent Point-of-care checks and personal protective equipment use while also mitigating staff exposure risk which is timely in the advent of the COVID-19 pandemic. Although most nursing staff have limited exposure and training on CGM technology, early studies show that CGM use in the hospital is well received by nurses. SUMMARY Given the evidence in the current literature regarding CGM use in the hospital, CGM devices may be incorporated in the inpatient setting.
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Affiliation(s)
- Chikara Gothong
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine
| | - Lakshmi G. Singh
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore
| | - Medha Satyarengga
- Center for Diabetes and Endocrinology, University of Maryland Shore Regional Health, Easton, Maryland, USA
| | - Elias K. Spanakis
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore
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