ORLANDO, FL — Steady glucose monitoring (CGM) of hospitalized sufferers with diabetes may present early and essential clues about altering insulin wants and cut back the necessity for a lot of blood attracts. Nonetheless, extra analysis is required to create the processes wanted to benefit from this strategy to care.
That was the message of researchers who introduced their analysis on CGM testing right here on the American Diabetes Affiliation (ADA) 84th Scientific Classes. A number of the most superior analysis on CGM use in hospitalized sufferers has been performed at Stanford Drugs, the place CGM outcomes have been built-in into digital well being data (EHRs).
CGM outcomes appeared to fall inside acceptable ranges for 99.3% of samples checked towards finger-stick blood glucose (FSBG) testing, or paired validations, stated Susan Seav, MD, of Stanford Drugs, California.
The challenge used the methdology of a Clarke error grid evaluation to verify CGM outcomes towards FSBG. Many of the paired CGM-FSBG outcomes — 87.7% or 1315 of 1506 — fell into Clarke zone A, that means they have been thought of clinically correct.
One other 11.6% fell into Clarke zone B, which is taken into account a benign error, that means these readings would probably not result in inappropriate therapy. Lower than 2% fell into the extra regarding decrease Clarke zones C, D, and E.
“Our information are reassuring that CGM use within the hospital can be protected for insulin use, however I’d say that cautiously as a result of we did not consider for security occasions,” Seav advised Medscape Medical Information in an interview.
The challenge, which concerned 135 sufferers, reveals it might be possible to combine CGM monitoring into EHRs, though extra analysis is required, Seav stated.
There’s a rising want to handle the potential for CGM use for hospitalized sufferers because of the rising reputation of those gadgets, such because the Dexcom and Libre screens.
A 2023 research based mostly on survey information discovered the prevalence of CGM use amongst individuals with diabetes in the USA rose from 0.4% in 2014 to 4.1% in 2020, Seav famous throughout her presentation. As well as, one other research, which used EHRs at a big tutorial medical middle within the Southeastern United States, discovered month-to-month charges of CGM prescriptions for brand spanking new customers grew 36% from 2020 to 2021.
The ADA helps continued use of CGM when clinically acceptable throughout hospital stays. The Endocrine Society recommends use of CGM with confirmatory bedside point-of-care blood glucose monitoring for adults with insulin-dependent diabetes hospitalized for noncritical diseases who’re prone to hypoglycemia.
But hospital workers, together with nurses, typically do not know what to do when their sufferers are utilizing CGMs.
“They do not know what a CGM is, not to mention the way it works,” Seav stated. “Extra importantly, how do nursing workers or personal groups know if that is permitted or protected to proceed to make use of?”
In response, Seav and Ming Yeh Lee, MD, PhD, and colleagues designed a protocol to attempt to handle these questions. Working below the route of Michael S. Hughes, MD, this Stanford staff adopted the 135 volunteers by way of 185 hospitalizations. They discovered sufferers and nurses noticed benefits to continued use of CGM.
Wanting on the outcomes of 46 sufferers’ experiences, the Stanford researchers discovered 63% reported liking the best way their blood sugar had been monitored. Outcomes for 27 nurses who reported on their experiences discovered 80% most well-liked CGM to FSBM.
Researchers are also simply starting to take a look at whether or not CGM may enhance outcomes for sufferers.
On the ADA session, Kristen L. Flint, MD, of Massachusetts Normal Hospital, Boston, famous that few research have been performed to see if CGM may have an effect on hospital-related medical outcomes within the inpatient setting.
She then introduced the outcomes of a 326-patient research performed at Massachusetts Normal Hospital from July 2021 to Could 2023.
This research concerned sufferers who have been seen exterior the intensive care unit (ICU), with members thus staying on flooring corresponding to oncology, surgical procedure, and neurology. All members had a blinded Dexcom sensor positioned, thus, real-time sensor information weren’t obtainable to the medical groups. These sensors have been eliminated early when members have been transferred to the ICU or in the event that they wanted an MRI, she stated.
Utilizing multivariable regression analyses, Flint and colleagues discovered that hyperglycemia recognized by CGM was related to 30-day emergency room visits.
“From this we really feel that CGM could assist establish sufferers within the hospital who would profit from elevated help after hospital discharge,” she stated.
Bigger longer-term research are wanted to completely reply questions concerning the potential of CGM to enhance post-discharge outcomes, Flint stated. She additionally famous that within the research she introduced, glycemic variability sufferers skilled could not have been detected, partially as a result of they didn’t use modifiers for severity of sickness. The research additionally could not have picked up glucose fluctuations sufferers skilled earlier of their stays.
“I do surprise in the event you put a CGM on a affected person to start with and also you acquire all of that information if we’d have stronger associations with outcomes,” she stated.
Michael Hughes has reported receiving funding from the Nationwide Institutes of Well being (NIH)/Nationwide Institute of Diabetes and Digestive and Kidney Illnesses (NIDDK) and has served as a advisor for Dexcom. Flint has reported receiving help from the NIH/NIDDK and an investigator-initiated research grant from Dexcom.
Kerry Dooley Younger is a contract journalist based mostly in Washington, DC.
