By Veronica Brady, APRN, BC-ADM, CDCES, MSN, NP, RN
Have you ever thought about what it must be like to enter a hospital and be told that you must remove your continuous glucose monitoring (CGM) device? Not because it failed or due to testing, but because “we don’t use them in the hospital.” As providers, we need to examine some the things we ask of our patients from their perspective. Just because things are uncomfortable for us or require that we go through some additional steps, does not mean they are not in the best interest of our patients.
Several weeks ago, I had a patient with type 1 diabetes utilizing an insulin pump with CGM admitted for an infection. At the time of admission, a diabetes management consult was placed. When I went to see her, she was quite irate. She informed me that she had had type 1 diabetes since the age of 11 and had been using an insulin pump with a sensor successfully for several years. However, because she was hospitalized, she was no longer able to use the information from her CGM to determine how to manage her glucose. Once she was admitted to the hospital, she had been told she was no longer allowed to use her CGM device. Instead, she had to use the hospital’s meter to determine glycemic management (prandial and basal insulin needs). Why? Because that is the hospital’s policy.
Recent studies evaluating the use of CGM in the hospital have shown that it is useful for the detection of hypoglycemia, decreasing the percentage of time with hyperglycemia and lowering mean daily glucose.
I argue that there are three valid reasons we should allow CGM in all hospital settings.
1. Technology makes life easier. As providers we understand that technology has made diabetes management easier over the years. The development of the CGM has allowed people with diabetes far more freedom than they have had in the past. Therefore, it does not stand to reason that the benefits of this technology are nullified upon admission to the hospital.
2. CGM produces positive outcomes. Recent studies evaluating the use of CGM in the hospital have shown that it is useful for the detection of hypoglycemia, decreasing the percentage of time with hyperglycemia and lowering mean daily glucose [1](2). That being said maybe we need to find ways to work with the technology that our patients are currently utilizing rather than resorting to the standard of care, because “that is the way we have always done it.”
3. It is our duty to do what is best for our patients. As patient advocates, clinicians and researchers it is incumbent upon us to identify and use evidence-based practice in the care of our patients with diabetes who are hospitalized. For example, one suggestion may be to allow them to continue to use their CGM but utilizing our hospital meter for insulin dosing.
It would behoove us to find a way to allow the continued use of this technology once the patient enters the portals of the hospital.
References
1. Galindo, R.J., et al., Comparison of the FreeStyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients With Type 2 Diabetes (T2D) Treated With Basal-Bolus Insulin Regimen. Diabetes Care, 2020.
2. Fortmann, A.L., et al., Glucose as the Fifth Vital Sign: A Randomized controlled Trial of Continuous Glucose Monitoring in a Non-ICU Hospital Setting. Diabetes Care, 2020
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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