Continuous Glucose Monitoring in Noncritical Care Hospital Settings
The use of continuous glucose monitoring (CGM) in noncritical care hospital settings has the potential to enhance glycemic control and reduce hospital stays for patients with type 1 or type 2 diabetes mellitus. In this article, we explore the practicality and benefits of implementing CGM technology in non-intensive care unit (non-ICU) hospital settings and discuss the key considerations for its successful application.
The Impact of Diabetes in Hospital Settings:
In Italy, a significant proportion of patients with diabetes face hospitalization at least once a year, with hospitalization rates seven times higher among diabetic patients compared to those without diabetes. Complications in managing hospitalized diabetes patients can lead to extended hospital stays and increased mortality. Thus, effective glycemic control is crucial in this context.
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Challenges of Point-of-Care Testing:
The foundation of glycemic control in hospitals is point-of-care blood glucose testing. However, this method has limitations, such as not providing a comprehensive 24-hour glycemic profile and inadequately detecting hypoglycemia, particularly during the night or in asymptomatic episodes. These shortcomings necessitate the exploration of more comprehensive alternatives.
The Role of Continuous Glucose Monitoring:
Continuous glucose monitoring systems, including real-time CGM, flash glucose monitoring, and intermittently scanned Continuous Glucose Monitor, offer advantages over traditional point-of-care testing. These benefits encompass increased monitoring frequency without disrupting patients, reduced discomfort, improved glycemic control, and a better prediction of hyper- and hypoglycemia. CGM also reduces the risk of nursing exposure to infectious diseases and minimizes the time required to obtain blood glucose values.
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Addressing Limitations:
Despite its potential benefits, CGM use in hospital settings faces challenges, including regulatory approval issues, sensor drift, calibration requirements, and potential interference from concurrent medication or substance use. These limitations underscore the need for further research and validation.
Towards a Practical Model:
The article proposes a practical model for implementing CGM in non-ICU settings, covering patient selection, sensor insertion, alarm setting, diabetes consultations, and hospital discharge with follow-up instructions for patients and caregivers.
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The Path Forward:
The use of CGM in noncritical care settings shows promise in improving hospital care efficacy, reducing patient stays, and enhancing glycemic control. Implementing structured CGM hospital protocols can help identify system advantages and patient suitability while streamlining data interpretation.
Conclusion:
While CGM in noncritical care settings holds great potential, further research is required to quantify its impact on nursing workflow, implementation burden, and economic implications. Continued studies will shed light on the full extent of CGM’s benefits in optimizing diabetes management in hospital environments.
