Insulin Pump Patient Characteristics and Glucose Control in the Hospitalized Setting

Abstract

Patients' knowledge of their insulin pumps and glucose control during hospitalization has not been studied. The aim was to study the determinants of glycemic control in patients using continuous subcutaneous insulin infusion (CSII) in the hospital. Three groups of patients were identified: those who did not need any inpatient education and continued on CSII (gorup A), those who received education then continued on CSII (group B), and those for whom CSII was not appropriate and were treated with multiple daily insulin injections (gorup C). We compared the measures of glycemic control between the 3 groups and analyzed which variables impacted glucose control. There were 50 patients, with 51 hospital admissions, 57% males, mean age 48 ± 13 years, 86% had type 1 diabetes (T1DM). The mean DM duration was 26 ± 14 years, mean duration of CSII use was 8.7 ± 6 years, and mean HbA1c was 7.6 ± 1.4%. The mean duration of hospital stay was 5.6 ± 4.6 days. Mean blood glucose (BG) and frequency of hyperglycemia and hypoglycemic events among the 3 groups adjusted for their duration of hospital stay were not statistically different. None of the patients developed diabetic ketoacidosis while using their pump.Stepwise multivariate analysis revealed knowledge of hypoglycemia correction was the single most important predictor of mean BG (P < .001). Patients who received inpatient education performed similarly to patients who did not need inpatient education. Patients who receive inpatient education on CSII fare similar as patients who did not require inpatient education.

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

“…There were no differences in the mean daily glucose levels; however, there were significantly fewer episodes of severe hyperglycemia (glucose >350 mg/dL [19.4 mmol/L]) and hypoglycemia (glucose <40 mg/dL [2.2 mmol/L]) in those who continued CSII compared with those taken off the pump (32). Similarly, a more recent study on 50 patients with 51 hospital admissions, 86% of whom had T1D, also reported no differences in mean blood glucose (BG), frequency of hyperglycemia, or hypoglycemic events among patients treated with CSII compared with those who were transitioned to a multiple daily injection (MDI) regimen (33). The authors concluded that with appropriate patient selection and usage guidelines, most patients using insulin pumps could safely have their therapy transitioned to the inpatient setting.…”

“…Reasons for discontinuing pump therapy at the time of admission were lack of additional pump supplies, threats of suicide or actual suicide attempts, malfunction of the pump, and altered level of consciousness. In a different study, the reasons for CSII discontinuation included patient preference, inability to safely demonstrate pump settings, and inexperience owing to recent initiation of CSII, while inability to correctly demonstrate appropriate pump settings, lack of family support, and postoperative mental status precluded restarting use of the insulin pump upon discharge (33).…”

“…Many patients undergoing ambulatory and short-term surgical procedures for up to 2–3 h could continue using their CSII device during the procedure (18,25,33,38,42). Table 3 includes a recommended insulin pump protocol for minor surgical procedures with anticipated length of surgery <2 h. This decision is to be based on the length of the procedure, postoperative recovery time, and whether exposure to an electromagnetic field (MRI, computed tomography, therapeutic radiation, or electric shock for defibrillation) is expected during or after surgery (Fig.…”

Continuous Glucose Monitoring Use in Hospitalized Patients

“…As with insulin pumps, 25 patients and providers will have varying knowledge of the capability and limitations of these devices. Thus, institutions need to set policies for safe management, 26 if they are to be allowed at all.…”

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

“…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].…”