Consensus Statement on Inpatient Use of Continuous Glucose Monitoring

Wallia, Amisha; Umpiérrez, Guillermo E.; Rushakoff, Robert J; Klonoff, David C.; Rubin, Daniel J.; Golden, Sherita Hill; Cook, Curtiss B.; Thompson, Bithika

doi:10.1177/1932296817706151

Cited by 104 publications

(114 citation statements)

References 52 publications

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“…Real-time continuous glucose monitoring (CGM) provides frequent measurements of interstitial glucose levels, as well as direction and magnitude of glucose trends, which may have an advantage over POC glucose testing in detecting and reducing the incidence of hypoglycemia in the hospital setting (28,29). Several inpatient studies have shown that CGM use did not improve glucose control but detected a greater number of hypoglycemic events than POC testing (30,31).…”

Section: Continuous Glucose Monitoringmentioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

182

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. In the hospital, both hyperglycemia and hypoglycemia are associated with adverse outcomes, including death (1,2). Therefore, inpatient goals should include the prevention of both hyperglycemia and hypoglycemia. Hospitals should promote the shortest safe hospital stay and provide an effective transition out of the hospital that prevents acute complications and readmission. For in-depth review of inpatient hospital practice, consult recent reviews that focus on hospital care for diabetes (3,4). HOSPITAL CARE DELIVERY STANDARDS Recommendation 15.1 Perform an A1C on all patients with diabetes or hyperglycemia (blood glucose .140 mg/dL [7.8 mmol/L]) admitted to the hospital if not performed in the prior 3 months. B High-quality hospital care for diabetes requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. "Best practice" protocols, reviews, and guidelines (2) are inconsistently implemented within hospitals. To correct this, hospitals have established protocols for structured patient care and structured order sets, which include computerized physician order entry (CPOE). Considerations on Admission Initial orders should state the type of diabetes (i.e., type 1 or type 2 diabetes) or no previous history of diabetes. Because inpatient insulin use (5) and discharge orders (6) can be more effective if based on an A1C level on admission (7), perform an A1C test on all patients with diabetes or hyperglycemia admitted to the hospital if the test has not been performed in the prior 3 months (8). In addition, diabetes self-management knowledge and behaviors should be assessed on admission and

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Section: Continuous Glucose Monitoringmentioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

182

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“…The technology used to measure interstitial glucose used by the majority of CGMs is affected by substance interference, most notably acetaminophen, but also dopamine, mannitol, heparin, ascorbic, uric and salicylic acid; many of which are commonly used in post-operative cardiac surgical care. [17] Acetaminophen is hydrolyzed and converted into indophenol, which can be followed at 600nm and has been shown to be directly affected proportional to the amount of acetaminophen present. [18] Additional risks specific to intravenous CGMS include concerns of thrombus or biofilm formation, occlusion, and catheter-related infections, rendering them less reasonable options for patients at high risk with other indwelling tubes, catheters and devices.…”

Section: Types Of Continuous Glucose Monitoring: Current Technologymentioning

confidence: 99%

Continuous Glucose Monitoring in the Cardiac ICU: Current Use and Future Directions

Scrimgeour¹

2017

CMR

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Perioperative glucose control is highly important, particularly for patients undergoing cardiac surgery. Variable glucose levels before, during and after cardiac surgery lead to increased post-operative complications and patient mortality. [1] Current methods for intensive monitoring and treating hyperglycemia in the Intensive Care Unit (ICU) usually involve hourly glucose monitoring and continuous intravenous insulin infusions. With the advent of more accurate subcutaneous glucose monitoring systems, the role of improved glucose control with newer systems deserves consideration for widespread adoption.

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“…Continuous glucose monitoring (CGM) provides frequent measurements of interstitial glucose levels, as well as direction and magnitude of glucose trends, which may have an advantage over POC glucose testing in detecting and reducing the incidence of hypoglycemia (24). Several inpatient studies have shown that CGM use did not improve glucose control but detected a greater number of hypoglycemic events than POC testing (25).…”

Section: Continuous Glucose Monitoringmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

156

View full text Add to dashboard Cite

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Consensus Statement on Inpatient Use of Continuous Glucose Monitoring

Cited by 104 publications

References 52 publications

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

Continuous Glucose Monitoring in the Cardiac ICU: Current Use and Future Directions

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

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