Continuous Glucose Monitor Shows Potential for Early Hypoglycemia Detection in Hospitalized Patients

Abstract

Data from the CGMS iPro Recorder illustrate the potential benefit of using a real-time CGM in the hospital to detect hypoglycemia in a more timely fashion compared to infrequent point-of-care glucose meter measurements.

Inpatient Continuous Glucose Monitoring and Glycemic Outcomes

“…55 While the Sensors review focused on ICU CGM, we also highlighted the limited number of non-ICU CGM studies, a setting where there is less frequent patient monitoring. [43][44][45]56,57 Non-ICU patients, especially T1DM patients with a high likelihood of labile inpatient glycemic control 58 and hypoglycemic unawareness, may benefit most from CGM. In general, the non-ICU studies reflect increased hypoglycemia detection with CGM (Table 2).…”

“…56 Only one other case report documents T1DM CGM initiation in the non-ICU setting, albeit blinded. 57 The majority of ICU CGM studies use established protocols for intravenous insulin infusion, [32][33][34]38 in which capillary BG is usually monitored hourly, which may obviate the need for subcutaneous CGM. Hyperglycemic ICU patients not receiving continuous insulin infusion may benefit from CGM, as they are less likely to receive frequent glycemic monitoring.…”

Multicenter Observational Study of the First-Generation Intravenous Blood Glucose Monitoring System in Hospitalized Patients

“…89 Clinicians in the future may utilize this near-continuous glucose monitoring system to perform a prospective randomized clinical trial to determine whether clinical outcome can be improved (decreased morbidity, mortality, length of stay, and hospital cost) as a result of optimized insulin therapy and BG control (avoidance of hyperglycemia, hypoglycemia, and glycemic variability). 61,79,90 A nearcontinuous IV glucose monitoring system that is safe, accurate, reliable, and user-friendly has great potential to be integrated with a computer controller and infusion pumps for IV insulin and IV glucose to produce a closed-loop in-hospital artificial pancreas. [63][64][65][66][67][68][69]91 Key Messages 1.…”

Vascular Glucose Sensor Symposium

“…[64][65][66][67][68][69][70] CGMS could become the standard of care for BG management if the systems are easy to use in the clinical setting, significantly increase time in the target BG range, and eliminate the risk for moderate/severe hypoglycemia ( Tables 1, 2, and 3). [64][65][66][67][68][69][70][71][72] Caregivers will observe the CGM data display during each patient encounter to assess the (1) glucose concentration (mg/dl or mmol/liter), (2) direction of glucose change (increasing, decreasing, or stable), and (3) rate of glucose change (slow, fast, or stable). The dose of intravenous (IV) and subcutaneous insulin will be adjusted frequently according to the glucose trend data using clinical protocols and computer algorithms.…”