Reducing Inpatient Hypoglycemia in the General Wards Using Real-time Continuous Glucose Monitoring: The Glucose Telemetry System, a Randomized Clinical Trial

Abstract

Use of real-time continuous glucose monitoring (RT-CGM) systems in the inpatient setting is considered investigational. The objective of this study was to evaluate whether RT-CGM, using the glucose telemetry system (GTS), can prevent hypoglycemia in the general wards. RESEARCH DESIGN AND METHODS In a randomized clinical trial, insulin-treated patients with type 2 diabetes at high risk for hypoglycemia were recruited. Participants were randomized to RT-CGM/ GTS or point-of-care (POC) blood glucose testing. The primary outcome was difference in inpatient hypoglycemia. RESULTS Seventy-two participants were included in this interim analysis, 36 in the RT-CGM/ GTS group and 36 in the POC group. The RT-CGM/GTS group experienced fewer hypoglycemic events (<70 mg/dL) per patient (0.67 [95% CI 0.34-1.30] vs. 1.69 [1.11-2.58], P 5 0.024), fewer clinically significant hypoglycemic events (<54 mg/dL) per patient (0.

Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19

“…Glucose telemetry systems using the Dexcom Share feature have also been described. 33 However, no commercial system currently integrates with the EHR or with intravenous insulin software programs.…”

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

“…40,41 Continuation of an outpatient CGM during a hospitalization could improve patient satisfaction and efficacy of glycemic monitoring by assisting the patient and the hospital staff to identify glucose patterns, and predict future glycemia with trend arrows and rate of change, 42 and potentially prevent severe hypo- and hyperglycemic events. 43 This would be particularly relevant if staffing shortages exist or a patient is no longer aware of hypoglycemia. Accordingly, asking patients to remove their CGMs in the hospital could potentially contribute to decreased patient satisfaction and quality of care.…”

“…Additionally, CGM technology could potentially replace many uses of POC capillary BG testing in the hospital. 43 However, if CGM readings turn out to be inaccurate, then more confirmatory testing would be needed and that could increase workload.…”

“…A recently published manuscript evaluated whether such a system for presenting CGM data, called the “Glucose Telemetry System,” can decrease hypoglycemia in the general wards/non-ICU setting. 43 This report is the first interventional randomized controlled trial (RCT) study of CGM technology to improve outcomes in the non-ICU setting. The study included patients with T2DM, who were at high risk for hypoglycemia.…”

Proposed Use of Continuous Glucose Monitoring for Care of Critically Ill COVID-19 Patients

“…Although developed for the outpatient setting, with a little ingenuity (and help from manufacturers), these devices can work in the inpatient setting. 6,14 Combined with the positioning of the IV pole out of the room, CGMs could obviate the need for bedside glycemic care.…”