Real-Time Continuous Glucose Monitoring in the Hospital Identifies and Prompts Treatment for Hypoglycemia

Reliance on point-of-care (POC) blood glucose measurements for inpatient diabetes management can result in long between-measurement intervals, which contribute to undetected and untreated dysglycemia. The G6 real-time continuous glucose monitoring (RT-CGM) system (Dexcom) allows for remote monitoring. In the hospital, this may reduce the need for close interactions and infectious disease transmission between patients and hospital staff. A man in his mid-60s was admitted to a non-intensive care unit in an acute care facility with a diagnosis of COVID-19. His preadmission type 2 diabetes was managed with twice-daily intermediate-acting insulin and prandial rapid-acting insulin;steroids and POC glucose testing (prandial and bedtime with a FreeStyle Precision Pro meter [Abbott]) were added to this regimen. A G6 was placed on the abdomen and was set to alert the staff to glucose values ≤85 mg/dL or predicted to be <55 mg/dL within 20 minutes. Two hypoglycemic events occurred which triggered three G6 alerts (Figure) . The G6 alerts prompted ad hoc POC measurements that confirmed the hypoglycemic events, prompted appropriate interventions, and documented the patient's return to euglycemia. All seven G6 readings were within 20 mg/dL or 20% of POC values ≤100 or >100 mg/dL, respectively. Inpatient RT-CGM use can detect existing or impending hypoglycemia and assist in diabetes management.

Practical implementation of remote continuous glucose monitoring in hospitalized patients with diabetes.

PURPOSE: Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates. METHODS: Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via fingerstick blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values. RESULTS: A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations. CONCLUSION: rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.