Researchers analyzed the efficacy of continuous glucose monitoring as the standard of care for diabetes management in an inpatient setting.
Overtaking the use of capillary glucose testing in a hospital setting, researchers suggest continuous glucose monitoring (CGM) be the standard of care for inpatient diabetes management. While they identified a need for more research on CGM use for hospitalized patients, researchers confirmed its increasing efficacy within an inpatient setting and its revolutionary history as the premier tool for diabetes management.
“In the 1990s, most patients with diabetes admitted to the hospital received no changes in their treatment or glucose monitoring during their hospital stay. Management of dysglycemia relied solely on the widespread use of insulin sliding scales, a reactive approach to management, waiting for hyperglycemia to occur to correct it,” wrote authors of the study.1 “CGM has proven to be a valuable tool for glycemic control and has become the standard of care for diabetes care according to the American Diabetes Association for people on multiple insulin injections per day or continuous subcutaneous insulin infusions.”
With CGM, patients can monitor their glucose levels at all times of the day, receiving real-time (RT) notifications or intermittently scanned (IS) sensors—depending on the type of CGM they are using. Moving away from self-monitoring of blood glucose, CGM technology has changed the landscape of both type 1 and type 2 diabetes in ambulatory and outpatient settings.1,2
Conducting a historical overview of the literature surrounding CGM use for inpatients, researchers explored CGM in multiple clinical settings, its use post-COVID-19 pandemic, as well as its overall evolution, implementation protocols, and guidance for use in hospital settings.1
“Despite its benefits in the outpatient setting, CGM use in the hospital for glycemic monitoring or optimization is not yet approved by regulatory entities, despite being widely used during and after the [COVID-19] pandemic,” continued Zelada et al.1
Although CGM has been unable to pass regulatory entities for use in hospital settings, researchers have continued to highlight its success among hospitalized patients. CGM for inpatients was expanded further during the pandemic when the FDA granted non-objection for CGM use in hospitals.1 Since then, CGM use has been recommended as the standard of care in hospital settings.
In their review, researchers detailed CGM use in non-ICU and ICU settings, as well as special hospital clinical settings. They reported CGM’s ability to control hyperglycemia in non-ICU and ICU settings, with its use in special clinical settings dependent on hybrid protocols for administering its benefits.
Further confirming researchers’ recommendation, Finn et al analyzed the real-world accuracy of inpatient CGM use for critically ill (CI) and non-critically ill (NCI) patients at a safety-net hospital.3
Despite a universal definition failing to be presented, “safety-net hospitals have a common mission to provide care for Medicaid beneficiaries and those who are uninsured.”4
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In Finn et al’s study, CGM use for CI and NCI patients was deemed accurate and acceptable in a safety-net hospital setting.3 And while patients in these settings may be of lower socioeconomic backgrounds, CGM success may further exacerbate the issue of inaccessibility in indigent communities.
With Zelada et al confirming previous literature of CGM success in hospital settings, they then began to explain its continuous evolution and how CGM has great potential to be the overall standard of care in the future for both inpatient and outpatient settings, despite various hurdles.
“While there is increasing interest in the continuation of CGMs upon admission in patients who previously were using these devices in ambulatory settings, there is still a need for more education of the hospital clinical and administrative personnel, patients, and family members/caregivers. It is recommended to have established protocols or clinical guidelines in hospitals where CGM will be initiated and used during the hospitalization,” they wrote.1
Despite the continued overall success of CGM to treat diabetes, its adaption within hospital settings relies on several prerequisite procedures and protocols compatible with hospital operations, but researchers are confident in its evolution for use among inpatients, which they claim is ultimately inevitable as technology improves.
“We have seen the rapid and exciting spread of CGM use in the hospital setting over the last few years, and optimistically anticipate a continued movement to improve glycemic monitoring and diabetes care in hospitalized patients with newer diabetes technology,” they concluded.1
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