Inpatients on insulin effectively used personal CGMs during hospitalization

Allowing inpatients to use personal continuous glucose monitors (CGMs) for insulin dosing was feasible and received positive feedback from nurses and patients, one hospital found.

Researchers studied the effects of a new hospital policy that enabled patients with diabetes to use personal CGMs in lieu of fingerstick blood glucose monitoring for insulin dosing. The policy included requirements specific to each CGM, accuracy monitoring protocols, and electronic health record (EHR) integration. Results were published by Diabetes Care on Aug. 14.

From November 2022 to August 2023, 135 patients used the CGM protocol during a total of 185 inpatient encounters; 27% of patients had type 1 diabetes, and 24% had automated insulin delivery systems. The most commonly used CGMs were Dexcom G6 (44%) and FreeStyle Libre 2 (43%). The accuracy of each CGM was validated either once or twice daily, depending on the model. To be validated, a CGM had to provide a result within 20% of a fingerstick result when the blood glucose level was 70 mg/dL (3.9 mmol/L) or above and within 20 mg/dL (1.1 mmol/L) when the fingerstick result was lower than that. Of 1,506 CGM validation attempts, 87.8% met the criteria.

A total of 27 nurses and 46 patients completed user experience surveys about the protocol. Most nurses found glucose management under the protocol effective (74%), easy to use (67%), and efficient (63%). The majority (80%) of nurses preferred the system to fingersticks. Similarly, most patients liked the protocol (63%), reported positive interactions with nursing staff under it (63%), and felt no significant interruptions to their diabetes management (63%).

“By sharing our experience in establishing an inpatient CGM policy and workflow as standard clinical care, we aim to encourage similar adoption in other health care facilities. However, it is important to recognize that inpatient use of these devices is currently off label and comes with limitations,” the study authors wrote. Patients were required to sign an agreement before participating in the protocol to ensure that they understood both these factors, the authors noted.

Limitations of the study itself include the retrospective design (which included only data documented in the EHR as full CGM data was not available), and the authors noted that some institutions might lack the staff expertise to support such a system. They plan to further investigate the use of automated insulin delivery systems in the hospital as well as other applications for CGMs.