Hospital Diabetes Meeting 2022

Abstract

The annual Virtual Hospital Diabetes Meeting was hosted by Diabetes Technology Society on April 1 and April 2, 2022. This meeting brought together experts in diabetes technology to discuss various new developments in the field of managing diabetes in hospitalized patients. Meeting topics included (1) digital health and the hospital, (2) blood glucose targets, (3) software for inpatient diabetes, (4) surgery, (5) transitions, (6) coronavirus disease and diabetes in the hospital, (7) drugs for diabetes, (8) continuous glucose monitoring, (9) quality improvement, (10) diabetes care and educatinon, and (11) uniting people, process, and technology to achieve optimal glycemic management. This meeting covered new technology that will enable better care of people with diabetes if they are hospitalized.

Keywords: continuous glucose monitor; diabetes; electronic health record; hospital; insulin; technology.

Figure 1.

Opportunities to adopt, adapt, or develop standards and best practices in the CGM data pipeline. Reproduced from Xu et al. Abbreviations: CCD, Continuity of Care Documents; CDA, Clinical Document Architecture; CGM, continuous glucose monitor; CPT, Current Procedural Terminology; EHR, electronic health record; EMPI, Enterprise Master Patient Index; FHIR, Fast Healthcare Interoperability Resources; HIPAA, Health Insurance Portability and Accountability Act; HITRUST, Health Information Trust Alliance; HL7, Health Level 7; ICD-10, International Classification of Diseases 10th Revision; IEEE, Institute of Electrical and Electronics Engineers; LOINC, Logical Observation Identifiers Names and Codes; mHealth, mobile health; NIST CSF, National Institute of Standards and Technology Cybersecurity Framework; NPI, National Provider Identifier; OAuth, open authorization; OMOP, Observational Medical Outcomes Partnership; RxNORM, a normalized naming system for generic and branded drugs, and a tool for supporting semantic interoperation between drug terminologies and pharmacy knowledge base systems; SMART, Substitutable Medical Applications, Reusable Technologies; SNOMED, Systemized Nomenclature of Medicine; SOC2, System and Organization Controls type 2—Trust Services Criteria; UDI, Unique Device Identifier.

Figure 2.

The eCQM strategy recommendations. Reproduced with permission from Centers for Medicare & Medicaid Services. Abbreviations: API, application programming interface; CMS, Centers for Medicare and Medicaid; eCQM, electronic clinical quality measures; EHR, electronic health record; FHIR, Fast Healthcare Interoperability Resources.

Figure 3.

The continuous glucose monitor (CGM) data is aggregated from Glytec’s de-identified data pool. Figure is courtesy of Joseph A. Aloi. Abbreviation: GM, Glucommander.

Figure 4.

Multifactorial causes of hospital-related hyperglycemia. Causal factors are specific to the patient, their illness, and their treatment. Hyperglycemia can exacerbate some illness-specific factors and increase the need for treatment-specific factors, leading to a vicious cycle by which hyperglycemia causes further hyperglycemia. Reproduced with permission from Dungan et al. Abbreviation: HPA, hypothalamic-pituitary-adrenal axis.

Figure 5.

Relationship between mean blood glucose (BG) (mg/dL) and mortality, stratified by hemoglobin A1c (HbA1c) level. For patients with HbA1c less than 6.5%, higher mean BG is strongly associated with increased mortality. For patients with HbA1c greater than 8.0%, the opposite relationship is observed. Reproduced with permission from Krinsley et al.

Figure 6.

Unadjusted in-hospital coronavirus disease 2019 (COVID-19) mortality rates, March 1 to May 11, 2020, by diabetes status. Error bars show 95% confidence intervals. Data for age groups 0 to 39 years and 40 to 49 years for type 1 diabetes and 0 to 39 years and 50 to 59 years for no diabetes have been excluded because of small numbers of events (one to four), to comply with data protection regulations. Reproduced with permission from Barron et al.

Figure 7.

Personalized treatment in non-intensive care unit (non-ICU) hospitalized patients with type 2 diabetes. Regimen complexity refers to the number and type of agents (oral agents, glucagon-like peptide-1 [GLP-1] receptor agonist, and insulin) used in the outpatient setting, with more complex regimens referring to those including multiple agents and/or insulin therapy. SSI refers to use of correctional sliding-scale insulin. Patients on multiple agents are likely to have worsening hyperglycemia if all preadmission agents are stopped and may respond better to basal + OAD or a basal-bolus approach. Reproduced with permission from Galindo et al. Abbreviations: HbA1c, hemoglobin A1c; OAD, oral antidiabetic drug; SSI, sliding-scale insulin.

Figure 8.

Hypoglycemia detection by POC (filled bars) glucose testing and a FreeStyle Libre Pro CGM (open bars) in 134 insulin-treated hospitalized patients. Blood glucose monitoring was performed before meals and at bedtime or as clinically required. Reproduced with permission from Galindo et al. Abbreviations: CGM, continuous glucose monitor; POC, point of care.

Figure 9.

Comparison of length of stay between a cohort of patients cared for by an IDMS team and a non-IDMS group. The mean length of stay in patients comanaged by the IDMS team decreased from 7.8 days to 5.7 days over time (27% reduction). There was no significant change in length of stay in the non-IDMS group. Modified from Mandel et al under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/). Abbreviations: IDMS, inpatient diabetes management system.

Figure 10.

Recommendations on the course of action for hospitalized patient with type 1 diabetes wearing insulin pumps. Reproduced from Mendez et al. Abbreviations: CT, computed tomography; EGD, esophagogastroduodenoscopy; MRI, magnetic resonance imaging.

Figure 11.

Comparison of time to target and incidence of hypoglycemia between computer-guided intravenous insulin therapy (green bars) and subcutaneous insulin therapy (blue bars). In total, 100 patients were retrospectively studied in each group. Reproduced with permission from Jordan Messler. Originally presented at the Virtual Hospital Diabetes Meeting. Abbreviations: BG, blood glucose; ICU, intensive care unit.