Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational, with limited data on its accuracy in the hospital setting. RESEARCH DESIGN AND METHODSTo analyze the accuracy of Dexcom G6, we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within 15, 20, and 30% or 15, 20, and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or #100 mg/dL, respectively (% 15/15, % 20/20, % 30/30). Clinical reliability was assessed with Clarke error grid (CEG) analyses. RESULTSA total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n 5 4,067 matched glucose pairs) was 12.8%, and median ARD was 10.1% (interquartile range 4.6, 17.6]. The proportions of readings meeting % 15/15, % 20/20, and % 30/30 criteria were 68.7, 81.7, and 93.8%, respectively. CEG analysis showed 98.7% of all values in zones A and B. MARD and median ARD were higher in the case of hypoglycemia (<70 mg/dL) and severe anemia (hemoglobin <7 g/dL). CONCLUSIONSOur results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes.Continuous glucose monitoring (CGM) technology in the outpatient setting has transformed glucose monitoring for diabetes self-management, providing more comprehensive glycemic control data than intermittent point-of-care (POC) blood glucose (BG) monitoring and hemoglobin A 1c . Ambulatory use of CGM continues to expand as devices improve in accuracy, accessibility, ease of use, and standardization of metrics for CGM data reporting (1).

on behalf of the CRIC Study InvestigatorsRationale & Objective: Safe analgesic choices are limited in chronic kidney disease (CKD). We conducted a comparative analysis of harm from opioids versus nonsteroidal anti-inflammatory drugs (NSAIDs) in CKD.

Nonsteroidal anti-inflammatory drug use is common among patients with CKD but less so among those with worse kidney function or those who see a nephrologist. Initiation or discontinuation of nonsteroidal anti-inflammatory drugs is often associated with supplementation with or replacement by, respectively, other analgesics, including opioids, which introduces possible drug-related problems when taking these alternative analgesics.

Assessing the performance at self-management of patients with CKD is essential for effective strategies to safeguard care. We evaluated the use of a sick-day protocol with structured usability testing by patients with CKD. The Sick-Day Protocol is a selfmanagement protocol developed by National Health Service Highland in Scotland to prevent AKI, and it is made available through the Scottish Patient Safety Program on a "Medicine Sick Day Rules" card (1). The Sick-Day Protocol card describes a gastrointestinal or fever-related and volume-depleting illness; then, it directs patients to withhold specified medications and resume them when well (after 24-48 hours of eating and drinking normally). Five medication classes and examples are listed, including angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, diuretics, nonsteroidal anti-inflammatory drugs, and metformin. We recruited volunteers with stages 3-5 CKD from the Safe Kidney Care program (2). All participants independently scheduled and completed testing. The protocol was deemed exempt by the University of Maryland Baltimore Institutional Review Board. Usability testing sessions were conducted in a private room by a moderator and recorder. Participants were educated about the purpose of the Sick-Day Protocol and qualifying illnesses. The moderator presented the card to all participants and requested each to summarize it in their own words. The study team developed four scenarios representing commonly encountered medical problems. All were reviewed and adjudicated by two physicians (C.J.D. and J.C.F.) for clinical validity and population suitability. Participants were presented the scenarios, including one for which the Sick-Day Protocol would be appropriately activated (index) and one with nonqualifying illnesses, including nephrolithiasis, congestive heart failure, and a "minor" gastrointestinal illness. One half of the sample had scenarios presented in a fixed sequence, starting with the index. The remainder had the scenarios presented randomly. The moderator reviewed the mock patient's medications and comorbidities in each scenario and then, provided mock medication bottles. Participants were asked about the appropriateness of the Sick-Day Protocol, if any of the mock medications should be withheld in each scenario, and if so, which ones. Completion of each task was classified as a success or error. After completing

No abstract