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. 2024 Oct 1;47(10):1838-1845.
doi: 10.2337/dc24-0626.

Empowering Hospitalized Patients With Diabetes: Implementation of a Hospital-wide CGM Policy With EHR-Integrated Validation for Dosing Insulin

Ming Yeh Lee  1 , Susan M Seav  2 , Loice Ongwela  2 , Julie J Lee  3 , Rachel Aubyrn  4 , Fang Y Cao  5 , Anna Kalinsky  4 , Olivia Aparicio Ramos  4 , Yunzi Gu  2 , Kailee Kingston  1 , Maja Ivanovic  5 , Bruce A Buckingham  1 , Dimpi Desai  2 , Rayhan A Lal  1   2 , Marilyn Tan  2 , Marina Basina  2 , Michael S Hughes  2
Affiliations

Empowering Hospitalized Patients With Diabetes: Implementation of a Hospital-wide CGM Policy With EHR-Integrated Validation for Dosing Insulin

Ming Yeh Lee et al. Diabetes Care. .

Abstract

Objective: We aimed to assess the feasibility, clinical accuracy, and acceptance of a hospital-wide continuous glucose monitoring (CGM) policy with electronic health record (EHR)-integrated validation for insulin dosing.

Research design and methods: A hospital policy was developed and implemented at Stanford Health Care for using personal CGMs in lieu of fingerstick blood glucose (FSBG) monitoring. It included requirements specific to each CGM, accuracy monitoring protocols, and EHR integration. User experience surveys were conducted among a subset of patients and nurses.

Results: From November 2022 to August 2023, 135 patients used the CGM protocol in 185 inpatient encounters. This group included 27% with type 1 diabetes and 24% with automated insulin delivery systems. The most-used CGMs were Dexcom G6 (44%) and FreeStyle Libre 2 (43%). Of 1,506 CGM validation attempts, 87.8% met the 20% or 20 mg/dL (%20/20) criterion for CGM-based insulin dosing and 99.3% fell within Clarke zones A or B. User experience surveys were completed by 27 nurses and 46 patients. Most nurses found glucose management under the protocol effective (74%), easy to use (67%), and efficient (63%); 80% of nurses preferred inpatient CGM to FSBG. Most patients liked the CGM protocol (63%), reported positive CGM interactions with nursing staff (63%), and felt no significant interruptions to their diabetes management (63%).

Conclusions: Implementation of a hospital-wide inpatient CGM policy supporting multiple CGM types with real-time accuracy monitoring and integration into the EHR is feasible. Initial feedback from nurses and patients was favorable, and further investigation toward broader use and sustainability is needed.

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Conflict of interest statement

Duality of Interest. R.A.L. receives consulting fees from Abbott Diabetes Care, Adaptyx Biosciences, Biolinq, Capillary Biomedical, Deep Valley Labs, Gluroo, PhysioLogic Devices, Portal Insulin, and Tidepool; has served on the advisory boards for ProventionBio and Eli Lilly; and receives research support from Insulet, Medtronic, and Tandem. M.S.H. has consulted for Dexcom and has received research support from Dexcom, Insulet, and Tandem. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
User experience survey results from patients and nurses. A: Responses from nurses. B: Responses from patients. Survey questions were based on a five-point Likert scale and are depicted with more negative responses on the left (yellow) progressing to more positive responses on the right (blue).
See this image and copyright information in PMC

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