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

Montero, Alex; Dubin, J.; Sack, Paul; Magee, Michelle F.

doi:10.4239/wjd.v10.i9.473

Cited by 9 publications

(12 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 Concerns for inpatient use include the accuracy of continuous glucose monitoring data when acute physiological disturbances are present (ie, hypoxaemia, vasoconstriction, severe dehydration, and rapidly changing glucose concentrations in diabetic ketoacidosis) or chemical interference with glucose readings (eg, high doses of paracetamol [>4 g per day], salicylic acid, ascorbic acid). 18,116 Glucose monitoring devices should also be removed for certain procedures-with each company having their own list-such as MRI and diathermy. 117 Results from small clinical trials in patients with type 2 diabetes have suggested that real-time continuous glucose monitoring can be used successfully to improve glycaemic control in the hospital setting.…”

Section: Point-of-care Testing and Continuous Glucose Monitoringmentioning

confidence: 99%

Management of diabetes and hyperglycaemia in the hospital

Pasquel

Lansang

Dhatariya

et al. 2021

The Lancet Diabetes & Endocrinology

183

132

View full text Add to dashboard Cite

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.

show abstract

Section: Point-of-care Testing and Continuous Glucose Monitoringmentioning

confidence: 99%

Management of diabetes and hyperglycaemia in the hospital

Pasquel

Lansang

Dhatariya

et al. 2021

The Lancet Diabetes & Endocrinology

183

132

View full text Add to dashboard Cite

show abstract

“…Physicians, advanced practice providers (APP), Certified Diabetes Care and Education Specialists, and nurses with expertise in placement and use of CGM devices can help establish protocols for CGM use and insulin dosing, as well as for monitoring device accuracy (63). Another important issue is integrating results from a CGM device with the electronic medical record (EMR), including nursing documentation (64). Health care personnel are working under a high level of The accuracy of CGM can be diminished during the conditions of altered tissue perfusion as well as use of certain medications and substances.…”

Section: Continuous Glucose Monitoring (Cgm) Devices Vs Bedside Blood Glucose (Bg) Monitoringmentioning

confidence: 99%

A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

Korytkowski

Antinori-Lent

Drincic

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.

show abstract

“…In diabetes, evidence of the benefits of CDS mostly derives from ambulatory settings 21 22. Hospital benefits for diabetes have been mostly shown in studies using computerized physician order entry systems, connectivity technology-based intervention of point of care blood glucose transfer for analysis, case finding of in-need patients, and integrated algorithms for insulin dosing and adjustments 23–30. Most studies have been observational and descriptive.…”

Section: Introductionmentioning

confidence: 99%

Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

Pichardo-Lowden

Umpiérrez

Lehman

et al. 2021

BMJ Open Diab Res Care

View full text Add to dashboard Cite

IntroductionInnovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations.Research design and methodsThe tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9–4.4 mmol/L (70–80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.ResultsWhen active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.ConclusionEMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes.

show abstract

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

Cited by 9 publications

References 42 publications

Management of diabetes and hyperglycaemia in the hospital

Management of diabetes and hyperglycaemia in the hospital

A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes

Contact Info

Product

Resources

About