An Overview of Safety Issues on Use of Insulin Pumps and Continuous Glucose Monitoring Systems in the Hospital

Thompson, Bithika; Leighton, Melinda E.; Korytkowski, Mary T.; Cook, Curtiss B.

doi:10.1007/s11892-018-1056-7

Cited by 13 publications

(24 citation statements)

References 22 publications

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“…Although AID systems can be beneficial, five types of factors may preclude their use in the inpatient setting. 122,123,126 They can be divided into the following categories: (1) patient-related, (2) hospital-related, (3) device-related, (4) medication-related, and (5) surgical procedure-related. Examples of patient-related conditions in which AID systems should not be used are physical or psychiatric conditions, which can make patients incapable of self-managing an AID system in the hospital.…”

Section: Potential Barriersmentioning

confidence: 99%

“…Examples of hospital-related factors are situations where there are no policies in place that can safeguard the use of AID systems in the inpatient setting and delineate the roles of the patients, nurses, and HCPs. 123,126 Because only limited information is currently available about the use of AID systems in the hospital, further research is needed in order to provide evidence-based recommendations. 126 Another potential obstacle to the use of AID systems in the inpatient setting is the lack of nurses and HCPs who are adequately trained in the use and interpretation of data from the AID systems.…”

Section: Potential Barriersmentioning

confidence: 99%

“…123,126 Because only limited information is currently available about the use of AID systems in the hospital, further research is needed in order to provide evidence-based recommendations. 126 Another potential obstacle to the use of AID systems in the inpatient setting is the lack of nurses and HCPs who are adequately trained in the use and interpretation of data from the AID systems. However, it is unclear whether AID systems do or do not lead to increased workload for nursing and/or HCPs.…”

Section: Potential Barriersmentioning

confidence: 99%

See 2 more Smart Citations

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

Galindo

Umpiérrez

Rushakoff

et al. 2020

J Diabetes Sci Technol

Self Cite

103

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This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (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. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.

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Section: Potential Barriersmentioning

confidence: 99%

Section: Potential Barriersmentioning

confidence: 99%

Section: Potential Barriersmentioning

confidence: 99%

See 1 more Smart Citation

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

Galindo

Umpiérrez

Rushakoff

et al. 2020

J Diabetes Sci Technol

Self Cite

103

View full text Add to dashboard Cite

show abstract

“…Limited retrospective case series suggest a good safety record. The largest series ( n = 164 admissions) found no surgical site infections, mechanical failures, or hospital-acquired diabetic ketoacidosis[15,16]. Both retrospective studies and a single, small randomized trial suggest that when compared to usual care, inpatient CSII use is equivalent for hyperglycemia events and possibly superior in hypoglycemia prevention[17,18].…”

Section: Outpatient Technologies Adapted For Inpatient Use Csiimentioning

confidence: 99%

Future technology-enabled care for diabetes and hyperglycemia in the hospital setting

Montero¹,

Dubin

Sack³

et al. 2019

WJD

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Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging. Inpatient technology-enabled support systems are being designed, adapted and evaluated to meet this challenge. Insulin pump use, increasingly common in outpatients, has been shown to be safe among select inpatients. Dedicated pump protocols and provider training are needed to optimize pump use in the hospital. Continuous glucose monitoring (CGM) has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit (ICU) settings but data on cost effectiveness is lacking. CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns. Compared to unstructured insulin prescription, a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems. Relative efficacy and cost among these systems remains unanswered. An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital. These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.

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“…Although SMBG has been shown to improve glycemic control when used within a structured testing regimen, it cannot predict impending hypoglycemia or alert the patient to a current hypoglycemic state. CGMSs can record real-time glycemic values and trends by providing a large number of blood glucose recordings (7). However, they have not been widely used because of device limitations such as short sensor lifetimes and the need for SMBG for device calibration.…”

Section: Introductionmentioning

confidence: 99%

Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

Yao

et al. 2020

Braz J Med Biol Res

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Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4–10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (–0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [–2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.

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An Overview of Safety Issues on Use of Insulin Pumps and Continuous Glucose Monitoring Systems in the Hospital

Cited by 13 publications

References 22 publications

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

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

Future technology-enabled care for diabetes and hyperglycemia in the hospital setting

Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

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