CGM in the Hospital: Is It Ready for Prime Time?

Abstract

Purpose of Review The use of continuous glucose monitoring (CGM) in the hospital setting is growing with more patients using these devices at home and when admitted to the hospital, especially during the COVID-19 pandemic. Recent Findings Historically, most evidence for CGM use in the inpatient setting was limited to small studies utilizing outdated CGM technology and analyzing accuracy of sensor measurements. Previous studies have shown reduced sensor accuracy during extreme hypo- or hyperglycemia, rapid fluctuations of glucose, compression of the sensor itself, and in those who are critically ill. Studies that are more recent have shown CGM to have adequate accuracy and may be effective in reducing hypoglycemia in hospitalized patients; some studies have also showed improvement in time in target glycemic range. Furthermore, CGM may reduce nursing workload, cost of inpatient care, and use of personal protective equipment and face-to-face patient care especially for patients during the COVID-19 pandemic. Summary This review will describe the evidence for use of CGM in hospitalized critically ill or non-critically ill patients, address accuracy and safety considerations, and outline paths for future implementation.

A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials

“…• • Protocols for frequent nonadjunctive use of CGM: For example, CGM may directly inform adjustments of insulin infusions, although this has been limited to research settings 13,[88][89][90] or in response to the COVID-19 pandemic. 91,92 Protocols typically require periodic POC glucose measures, often at a lesser frequency than otherwise would be performed in clinical practice.…”

“…103 During the COVID-19 pandemic, reports have emerged on the use of protocols combining CGM and POC to guide intravenous insulin therapy; however, the safety of this approach needs further investigation. 92 Similarly, studies including patients with COVID-19 in non-ICU settings have focused on the feasibility of remote CGM use to decrease the burden of diabetes care, but there has been limited data on insulin dosing.…”

“…To address accuracy issues a hybrid approach has been recently recommended. 68,92,104 This includes the use of intermittent non-adjunctive CGM along with periodic POC testing to confirm accuracy with validation protocols. 91,105 While we wait for regulatory approval of CGM devices for inpatient use, a hybrid approach appears to have gained acceptance by investigators.…”

Continuous Glucose Monitoring Within Hospital: A Scoping Review and Summary of Guidelines From the Joint British Diabetes Societies for Inpatient Care

“…69 Accuracy may be affected with other substances (namely maltose, ascorbic acid, dopamine, mannitol, heparin, hydroxyurea, and salicylic acid) with certain devices. 11,58,70 Challenges and Future Directions Implementation of diabetes technology in hospital presents several challenges. 61 Continuous glucose monitoring devices are currently infrequently encountered in the hospital, therefore, hospital staff are unlikely to be familiar with their operation.…”

Real-Time Continuous Glucose Monitoring in the Hospital: A Real-World Experience

“…To date, only a handful of randomized-controlled trials (RCTs) have evaluated CGM in hospital settings. Recent reviews of studies evaluating CGM in ICU settings 23 and among hospitalized patients with COVID-19 24,25 show preliminary evidence of superior accuracy, detection, and glycemic control relative to POCT. A large multi-center trial examining the accuracy of CGM in non–critical care inpatient settings demonstrated promising findings in a larger, heterogeneous group of hospitalized patients.…”