Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic

Galindo, Rodolfo J.; Aleppo, Grazia; Klonoff, David C.; Spanakis, Elias K.; Agarwal, Shivani; Vellanki, Priya; Olson, Darin E.; Umpiérrez, Guillermo E.; Davis, Georgia; Pasquel, Francisco J.

doi:10.1177/1932296820932903

Cited by 112 publications

(93 citation statements)

References 35 publications

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“…Insufficient data as well as concerns about subcutaneous blood flow and the lag between true blood glucose and subcutaneous interstitial fluid glucose precluded its approval. However, further data supporting a reasonable correlation between CGM and a point-of-care blood glucose testing in non-ICU patients, 63 and between flash glucose monitoring and capillary blood glucose testing in hospitalized patients, 64 along with the urgent need to better manage patients with diabetes and COVID-19, prompted the FDA to grant approval for the use of CGM systems in the hospital. Adoption of CGM for inpatient use requires careful consideration and expertise, and more guidance would be beneficial for hospital-based clinicians.…”

Section: Management Of Diabetes In the Setting Of Covid-19 Infectionmentioning

confidence: 99%

COVID-19 in people living with diabetes: An international consensus

Caballero

Ceriello

Misra

et al. 2020

Journal of Diabetes and its Complications

124

149

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The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care worldwide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.

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Section: Management Of Diabetes In the Setting Of Covid-19 Infectionmentioning

confidence: 99%

COVID-19 in people living with diabetes: An international consensus

Caballero

Ceriello

Misra

et al. 2020

Journal of Diabetes and its Complications

124

149

View full text Add to dashboard Cite

show abstract

“… 20 Therefore, to simplify therapy, preserve PPE, and limit bedside interactions, academic centers and hospitals around the nation are adapting their inpatient diabetes care strategies in response to COVID-19. 12 To reduce interactions between patients and healthcare providers, limit exposure to COVID-19, and reduce the waste of PPE, the Food and Drug Administration (FDA) allowed the use of home-use blood glucose meters as an option to provide relief and support to healthcare professionals in the hospital. 32 In addition, the FDA did not object to the use of continuous glucose monitoring (CGM) devices in this setting.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is limited inpatient clinical experience with the two factory-calibrated CGM devices currently being implemented in hospitals to reduce bedside POC glucose monitoring. 12 …”

Section: Introductionmentioning

confidence: 99%

Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

Gujral

Johnson

et al. 2020

BMJ Open Diab Res Care

Self Cite

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The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.

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“…Other methods are needed to decrease nurse contact with the patient for assisted monitoring of BG (AMBG) 5 in order to (1) decrease risk of contagion from exposure to patients, (2) save time from donning and doffing PPE wherever possible, and (3) preserve limited supplies of PPE. 4 Despite limited guidance, established studies, or widespread support from the clinical community to use CGMs in acute care, 6 some healthcare professionals (HCPs) in the hospital diabetes community have recently begun to prescribe CGMs in the hospital setting for investigational or off-label use for COVID-19 patients. 7 The Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel included professionals from a variety of backgrounds.…”

Section: Introductionmentioning

confidence: 99%

“…For each of the five topics of this guideline (Table 1), six categories of recommendations (two for clinical practice, two for future research, and two for hospital policies) were developed for the main stakeholders of CGM and AID system technology in the hospital. These types of recommendations included (1) and (2) strong and mild recommendations that clinicians (HCPs or nursing) should do to utilize the technology optimally, (3) and (4) strong and mild recommendations that researchers and manufacturers need to do to improve the safety and effectiveness of the technology, and (5) and (6) strong and mild recommendations that hospitals need to do to build an environment for facilitating use of these devices. We define "should" as a statement of good practice and "need" as a necessary step to ensure patient safety or proper fulfillment of a procedure.…”

Section: Introductionmentioning

confidence: 99%

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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Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic

Cited by 112 publications

References 35 publications

COVID-19 in people living with diabetes: An international consensus

COVID-19 in people living with diabetes: An international consensus

Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

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

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