New Guidance on Use of CGM Technology in Hospitals, Especially During Pandemic
By Brenda L. Mooney, /alert Contributor
November 16, 2020
Especially for patients with type 1 diabetes, continuous glucose monitors (CGMs) are becoming an essential technology for improving glycemic outcomes. In recent years, greater adoption of CGMs have occurred with type 2 diabetes patients using insulin and, even more recently, the technology has been proposed for inpatient usage.
“The opportunity for a patient (or by way of wireless communication, a caregiver, or relative) to see real-time glucose concentrations tested automatically and continuously is transforming the practice of diabetes care,” wrote authors of a new report published in the Journal of Diabetes Science and Technology.
Emory University-led panelists sought to create a consensus guideline for continuous glucose monitoring and automated insulin dosing systems in hospitals. Interestingly, the efforts began before the onset of the COVID-19, which has increased the need for devices that limit healthcare provider exposure to patients.
The article pointed out that more recent iterations of the devices offer “improved accuracy, smaller form factors, extended sensor life, and new data presentation software for translating data into increasingly useful metrics on various mobile platforms.” Furthermore, the authors noted, “Some new factory-calibrated CGMs have eliminated the need for finger-stick blood glucose (BG) testing by users (except at certain times per individual product instructions, such as soon after insertion, when there appear to be errors or no readings at all, when the CGM value does not match how the patient feels, or when an icon indicates the need for testing BG).”
Among the strong recommendations for hospitals is that they need develop or implement:
standard CGM data reports and workflows.
policies for testing capillary BGs and calibrating CGMs if the CGM requires calibration.
a system for automatic staff notification for CGM alarms that predict impending or current hypoglycemia or hyperglycemia.
specific guidelines for using CGMs and AID systems for their affiliated nursing homes and skilled nursing facilities.
“Escalating interest in utilizing CGMs and AID systems in a hospital setting has resulted in a need for guidance on the continuation of these technologies in the hospital setting. This interest has been stimulated by four trends in the application of CGM technology, including (1) improvements in the technology and human factors of CGMs, (2) an increasing number of patients wearing these devices in ambulatory settings, (3) growing interest by clinicians to understand and interpret their hospitalized patients’ glucose concentrations, and (4) an accumulation of published reports describing use of these products in investigational settings,” researchers explained.
The Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital: Consensus Guideline Panel was convened in April, including international panel experts in diabetes technology from the United States, Europe, and Australia. The expert panel included representatives from academia and government, as well as observers from government (FDA), and industry (Abbott Diabetes Care, Dexcom, Glytec, Medtronic, and Roche Diagnostics). Members also represented the College of American Pathologists, the Endocrine Society, and the Association of Diabetes Care and Education Specialists.
The meeting sought to provide guidance for clinicians on how and when to best use both subcutaneous CGMs and AID systems, as well as to promote clinical research utilizing these devices.
Two weeks prior to the panel meeting, two CGM companies announced that during the pandemic, the FDA had told them that it would not object if these companies provided devices and technical support to hospitals who ordered CGMs for off-label use, according to the report, which added, “Because some healthcare systems were interested in validating CGMs for use in their hospitals to preserve personal protective equipment (PPE) supplies and to minimize patient/provider contact, there was additional urgency for the panel to develop new clinical guidance.”
Background information in the article argued that “traditional approach of testing capillary BG every one to two hours in patients who are receiving intravenous insulin in an intensive care unit (ICU) as well as frequent BG testing in non-ICU wards for patients receiving subcutaneous insulin is not workable during the pandemic.”
The authors wrote that decreasing nurse contact risk of contagion from exposure to patients, saves time from donning and doffing PPE wherever possible, and preserves limited supplies of PPE.
Five topics were discussed by the expert panel: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of 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.