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Continuous Glucose Monitoring

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Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

Source:

Key Takeaway: During the COVID-19 pandemic, continuous glucose monitoring is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.


Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Source:

Key Takeaway: This guideline provides recommendations for the following: 1) continuation of home continuous glucose monitors (CGMs) after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of Automated Insulin Dosing (AID) systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital.


Glucose as the Fifth Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a Non-ICU Hospital Setting

Source:

Key Takeaway: The current standard for hospital glucose management is point-of-care (POC) testing; however, blinded continuous glucose monitoring (CGM) has retrospectively shown POC testing to miss ~ 33% of hyperglycemic and up to 90% of hypoglycemic events.  This RCT of 110 adults with type 2 diabetes compared real-time CGM (RT-CGM) using Dexcom G6 with POC in a non-ICU hospital setting.  RT-CGM data were wirelessly transmitted from the bedside.  Hospital telemetry monitored RT-CGM data and notified bedside nursing of glucose alerts and trends.  Standardized protocols were used for interventions.  The RT-CGM group demonstrated significantly lower mean glucose and percentage of time in hyperglycemia >250 mg/dL and higher median time in range 70–250 mg/dL compared with usual care.  Percentage of time in hypoglycemia was very low.  Researchers concluded RT-CGM can be used safely and successfully in a non-ICU hospital setting to improve glucose management.


Reducing Inpatient Hypoglycemia in the General Wards Using Real-Time Continuous Glucose Monitoring: The Glucose Telemetry System, a Randomized Clinical Trial

Source: Journal of Diabetes Science and Technology

Key Takeaway: Several studies have shown that abnormal glucose control in the inpatient setting is associated with adverse clinical outcomes, leading to increased health care expenditure. This randomized controlled trial explored whether the use of real-time CGM (rtCGM) and a Glucose Telemetry System (GTS), which wirelessly transmits CGM glucose values from the bedside to a centralized monitor at the nursing station, can decrease hypoglycemia among hospitalized high-risk patients with type 2 diabetes. Results from the interim analysis revealed that the RT-CGM/GTS intervention combined with a simplified hypoglycemia prevention protocol led to a decrease in inpatient hypoglycemia.

Hypoglycemic Events per Patient


Diabetes and Technology in the COVID-19 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: In the inpatient setting, the use of CGM devices will expand. In addition to reducing nursing or providers workload, which has been underscored during this healthcare crisis, CGM systems can have many other benefits: They can lead to intense glucose monitoring and therefore to early recognition and prevention of impending hypoglycemia. Glycemic trends could be identified easier leading to better insulin adjustments and improved glycemic control.

 


Implementing CGM for Hospitalized Patients With COVID-19 and Diabetes: Insights From One Medical Center

Source: EndocrinologyAdvisor

Key Takeaway: “First and foremost, our idea for using glucose sensors and remote glucose monitoring [at Rush University Medical Center] was to help the front-line nurses save time and PPE by not needing to go into the patients’ rooms to test the finger sticks. The second benefit of CGMs is that we feel the patients are safer. With forefinger sticks, you get a rough snapshot of diabetes control and it is easy to miss severe hyperglycemia and hypoglycemia. With the way we use remote glucose monitoring, we are able to detect and prevent most of these highs and lows [in glucose levels].”

“The reduced pricing options are really reasonable. There is still cost, but according to our economic analysis, the saving of PPE and of nurses’ time outweighs the cost of the sensor systems currently.”

 – Rasa Kazlauskaite, MD, MS, director of the diabetes technology program at Rush University and associate professor in the department of internal medicine at Rush Medical College in Chicago, Illinois.

 


Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: Given the importance of treating diabetes and uncontrolled hyperglycemia in every unit of the hospital, and the improvements in performance of current-generation CGM systems, we say why not continuously measure glucose in the hospital as well? The appropriate implementation of this technology may significantly decrease the burden of glucose monitoring for patients and providers. A systematic analysis of the experience gained during these unprecedented times will likely help transform inpatient diabetes care for the better.

 


Remote Glucose Monitoring of Hospitalized, Quarantined Patients with Diabetes and COVID-19

Source: Diabetes Care

Key Takeaway: In summary, converting a personal CGM system originally designed for diabetes self-management to team-based, real-time remote glucose monitoring offers a novel tool for inpatient diabetes control in COVID-19 isolation facilities. Such a solution in addition to ongoing remotely monitored clinical parameters (such as pulse rate, electrocardiogram, and oxygen saturation) adds to quality of diabetes care while minimizing risk of staff exposure and burden.

 


Interview with Carol Levy, MD, Clinical Director of the Mount Sinai Diabetes Center regarding Mount Sinai’s effort to make glucose management safer during COVID-19

Source: Endocrinetoday

Key Takeaway: “The advantages of [inpatient] CGM are less fingerstick testing and…more remote monitoring.” – Carol Levy, MD

 


Individualizing Inpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: Effective inpatient diabetes treatment approaches that can reduce the effort of medical staff resulting from multiple insulin injections and fingerstick testing, the waste of invaluable PPE, and patient discomfort during this pandemic are paramount. Not optimizing glycemic control due to clinical inertia driven by fear or lack of supplies may lead to poor outcomes in patients with diabetes and COVID-19. An individualized approach, as opposed to standardized regimens, may reduce these barriers during this pandemic. However, systematic evaluation of these changes in care is necessary to evaluate both patient- and community-centered outcomes.

 


Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Source: Journal of Diabetes Science and Technology

Key Takeaway: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer length of stay and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate.

 


A Pilot Study of the Feasibility and Accuracy of Inpatient Continuous Glucose Monitoring

Source: Diabetes Care

Key Takeaway: While there are limitations to these data including a small sample size, lack of blood glucose laboratory confirmation, and non–ICU admissions, we feel confident that the Dexcom G6 can be used safely in the hospital for patients infected with SARS-CoV-2. Now that the U.S. Food and Drug Administration has emergently approved CGM for use in the hospital, it will be easier to test all CGM devices in the hospital setting. This could potentially have major implications for inpatient glycemic management after the pandemic, and cost-to-benefit ratios will be important to consider. In our current situation, use of CGM could reduce the number of health care provider contacts and the need for personal protective equipment.