On rendering continuous glucose monitoring ready for prime time in the cardiac care unit

Abstract

Background: Although stringent glycemic control is beneficial for patients with diabetes who are hospitalized in a Cardiac Care Unit (CCU), implementation is difficult in part because of the imperative to avoid hypogolycemia with its particularly deleterious consequences in this setting. We therefore explored the potential value of use of a continuous glucose monitoring system to enhance glycemic control in the CCU and sought to identify pitfalls that could be overcome to increase its utility.

Method: This study was performed with a continuous glucose monitoring system (CGMS) manufactured by MiniMed (Northridge, California, USA), a division of Medtronic, Inc. The device used was originally designed for home use and was a prototype. Twenty patients with elevated concentrations of blood glucose who were hospitalized in our CCU were studied after randomization to standard care for diabetes or standard care supplemented by use of a CGMS.

Results: To optimize glycemic control, the need for favorable modifications in the prototype device initially designed for home use were identified and implemented as were the value of intense in-service training of nurses and optimal interactions with patients and their families.

Conclusions: Use of the CGMS was found to be helpful to nursing personnel. Acceptance of the use of the device, however, was contingent upon enabling patients to overcome fear underlying their often subconscious resistance to the use of insulin in the CCU by emphasizing differentiation of such usage from an increased probability of insulin dependence after recovery.