Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19

Faulds, Eileen R; Jones, Laureen; McNett, Molly; Smetana, Keaton S.; May, Casey C.; Sumner, Lyndsey; Buschur, Elizabeth; Exline, Matthew C.; Ringel, Matthew D.; Dungan, Kathleen

doi:10.1016/j.eprac.2021.01.011

Cited by 34 publications

(46 citation statements)

References 29 publications

(21 reference statements)

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“…During the COVID-19 pandemic, several institutions used CGM to minimize contact between health care providers and patients, especially those in the intensive care unit (41)(42)(43)(44)(45)(46)(47)(48)(49). This approach seems to be helpful in that regard, as well as helping to minimize the use of personal protective equipment.…”

Section: Continuous Glucose Monitoringmentioning

confidence: 99%

16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2022

2021

Diabetes Care

156

114

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the 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 (https://doi.org/10.2337/dc22-SPPC), 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 (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Section: Continuous Glucose Monitoringmentioning

confidence: 99%

16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2022

2021

Diabetes Care

156

114

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“…Many institutions relied heavily on the endocrinology team for nursing/clinician training, patient selection, device placement/set-up, and ongoing support [ 46 – 48 ]{Chow, 2021 #2947). While in other institutions, including the authors’, these tasks shifted rapidly to nursing [ 44 , 45 , 60 ]. A need for strong ongoing endocrinology support has been mentioned as a potential barrier to widespread implementation of CGM in the hospital setting [ 10 , 35 ], yet it appears many factors of CGM use can be independently integrated into nursing practice.…”

Section: Methodsmentioning

confidence: 99%

“…Each new sensor required validation prior to nonadjunctive use. Initial validation criteria were met if two consecutive hourly sensor glucose values were within 20% of the POC glucose if > 100 mg/dl or within 20 mg/dl of the POC glucose if < 100 mg/dl [ 45 ]. If the sensor was validated, the CGM was then used to adjust IV insulin with ongoing POC glucose validation of accuracy at least every 6 h. A POC glucose was also obtained if there was no CGM value, no trend arrow, an urgent low soon or low threshold alert, signs and symptoms that did not match the sensor glucose, change in clinical status (such as intubation, hemodynamic compromise, nutrition change), or a new sensor placement.…”

Section: Covid-19 Considerationsmentioning

confidence: 99%

CGM in the Hospital: Is It Ready for Prime Time?

2022

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Purpose of Review The use of continuous glucose monitoring (CGM) in the hospital setting is growing with more patients using these devices at home and when admitted to the hospital, especially during the COVID-19 pandemic. Recent Findings Historically, most evidence for CGM use in the inpatient setting was limited to small studies utilizing outdated CGM technology and analyzing accuracy of sensor measurements. Previous studies have shown reduced sensor accuracy during extreme hypo- or hyperglycemia, rapid fluctuations of glucose, compression of the sensor itself, and in those who are critically ill. Studies that are more recent have shown CGM to have adequate accuracy and may be effective in reducing hypoglycemia in hospitalized patients; some studies have also showed improvement in time in target glycemic range. Furthermore, CGM may reduce nursing workload, cost of inpatient care, and use of personal protective equipment and face-to-face patient care especially for patients during the COVID-19 pandemic. Summary This review will describe the evidence for use of CGM in hospitalized critically ill or non-critically ill patients, address accuracy and safety considerations, and outline paths for future implementation.

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“…Once initial validation was achieved, CGM data alone was used for clinical decision making and insulin titration with continuation of POC to maintain validation. After ICU transfer, CGM was used alone without POC [ 41 ]. Authors enrolled a total of 19 medical ICU patients requiring intravenous insulin managed by this protocol showing feasibility of this hybrid approach.…”

Section: Methodsmentioning

confidence: 99%

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

Gothong

Singh

Satyarengga

et al. 2021

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Continuous glucose monitoring (CGM) systems are Food and Drug Administration approved devices for the ambulatory setting; however, they remain investigational systems for inpatient use. This review summarizes the most recent and relevant literature on the use of continuous glucose monitoring in the hospital setting. Recent findings CGM provides real-time glucose data that enable healthcare professionals to make proactive and timelier clinical decisions with regards to diabetes management. CGM devices appear to be safe and accurate systems for glucose monitoring in the hospital setting. Real-time CGM systems and glucose telemetry can decrease hypoglycemia and reduce hyperglycemia in hospitalized patients with diabetes. Remote glucose monitoring decreases the need of frequent Point-of-care checks and personal protective equipment use while also mitigating staff exposure risk which is timely in the advent of the COVID-19 pandemic. Although most nursing staff have limited exposure and training on CGM technology, early studies show that CGM use in the hospital is well received by nurses. Summary Given the evidence in the current literature regarding CGM use in the hospital, CGM devices may be incorporated in the inpatient setting.

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Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19

Cited by 34 publications

References 29 publications

16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2022

16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2022

CGM in the Hospital: Is It Ready for Prime Time?

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

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