Hospitalized patients with diabetes or hyperglycemia are typically monitored through finger‐stick glucose checks 4 times a day. Intermittent monitoring of blood glucose can miss many glucose excursions, particularly in the postprandial and nocturnal periods.
The introduction of continuous glucose monitors (CGMs) is potentially a new method to treat hyperglycemia in the inpatient setting. CGM uses a sensor with a thin wire that is inserted under the abdominal skin. The sensor communicates with a monitor that records glucose levels every 5 minutes and displays trends for the past 9 hours. The data can be downloaded where glucose levels can be viewed in a tabular or graphical format. Alarms can be set to detect high‐ and low‐glucose levels as defined by the user. As they are not as accurate as traditional blood glucose monitors but indicate trends accurately, CGM does not replace standard glucose monitoring devices. In outpatient studies, the use of continuous glucose monitoring has been associated with improved glucose control in selected type 1 diabetics. There are additional studies of the use of CGM in intensive care units to assist with titration of insulin drips. To our knowledge, no published reports of the use of CGM on general medical units exist in the literature.
This pilot study used the Dexcom Seven® CGM in hospitalized adult patients with a primary diagnosis of a COPD exacerbation to improve the control of steroid induced hyperglycemia. After implantation of the sensor, nurses and physicians were able to access the trend graphs on the monitor at the bedside. Alarms for hypoglycemic values (<60) were set on the monitor. The use of the monitor has identified a number of significant hyper‐ and hypoglycemic events that would not have been detected using intermittent finger‐slick monitoring. The data from the CGM has allowed providers to adjust insulin regimens to improve glucose control and reduce hypoglycemic events. Patients have tolerated the placement of the sensor well, with little to no reported discomfort and no reported complications.
CGM potentially represents an innovative technology to improve the treatment of hyperglycemia in the inpatient setting. This technology could assist providers in earlier identification of glucose excursions and in tailoring insulin protocols. As the use of CGM in the inpatient setting is relatively new and to this date untested, the specific indications and populations of patients who may benefit from the use of CGM remain unclear. Further testing in prospective studies are needed to determine the utility and specific indications for this new technology.
S. Liu, none; D. Basta, none; J. Jacoby, none; R. Comi, none.
To cite this abstract:Liu S, Jacoby J, Basta D, Comi R. Use of Continuous Glucose Monitoring (CGM) to Improve Glucose Control in the Inpatient Setting. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 120. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/use-of-continuous-glucose-monitoring-cgm-to-improve-glucose-control-in-the-inpatient-setting/. Accessed May 26, 2019.