Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital

Abstract

The use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems has gained wide acceptance in diabetes care. These devices have been demonstrated to be clinically valuable, improving glycemic control and reducing risks of hypoglycemia in ambulatory patients with type 1 diabetes and type 2 diabetes. Approximately 30–40% of patients with type 1 diabetes and an increasing number of insulin-requiring patients with type 2 diabetes are using pump and sensor technology. As the popularity of these devices increases, it becomes very likely that hospital health care providers will face the need to manage the inpatient care of patients under insulin pump therapy and CGM. The American Diabetes Association advocates allowing patients who are physically and mentally able to continue to use their pumps when hospitalized. Health care institutions must have clear policies and procedures to allow the patient to continue to receive CSII treatment to maximize safety and to comply with existing regulations related to self-management of medication. Randomized controlled trials are needed to determine whether CSII therapy and CGM systems in the hospital are associated with improved clinical outcomes compared with intermittent monitoring and conventional insulin treatment or with a favorable cost-benefit ratio.

Continuous subcutaneous insulin infusion reduces the risk of postoperative infection

“…Regarding the evaluation of cost-effectiveness, CSII is generally considered superior over MDI in type 1 diabetes; 43 however, there is a lack of randomized controlled trials to determine whether CSII therapy is associated with a favorable cost-effectiveness in perioperative patients with hyperglycemia. 44 In the current study, although the cost of CSII therapy was higher than other insulin treatments, we did not observe a significant difference in the total hospital expenditure between the CSII group and non-CSII group. A probable explanation is that CSII therapy reduced other medical costs via improved postoperative outcomes and shortened hospital stay.…”

Diabetesmanagement im Krankenhaus (Update 2019)

“…Die Bolusinsulindosis kann entweder mit 1/6 der bisherigen Insulintagesdosis zu den 3 Hauptmahlzeiten angenommen werden oder errechnet nach Insulin/Broteinheiten-Verhältnis verabreicht werden. Ein Korrekturschema sollte zudem vorgegeben sein [69].…”

Drug Delivery Strategies for the Treatment of Metabolic Diseases

“…Over recent decades, it has gradually become more important for drug delivery strategies to face the challenges posed by different diseases. For example, insulin pumps release the required insulin from the replaceable reservoir to control blood glucose levels in people with diabetes . Alternatively, using continuous glucose monitors along with insulin pumps to automatically release appropriate doses of insulin is another insulin delivery strategy for the treatment of blood glucose disorder .…”