scholarly journals A Pragmatic Approach to Inpatient Diabetes Management during the COVID-19 Pandemic

2020 ◽  
Vol 105 (9) ◽  
pp. 3076-3087 ◽  
Author(s):  
Mary Korytkowski ◽  
Kellie Antinori-Lent ◽  
Andjela Drincic ◽  
Irl B Hirsch ◽  
Marie E McDonnell ◽  
...  
Keyword(s):  
Health Care ◽  
Diabetes Management ◽  
Prolonged Exposure ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Standards Of Care ◽  
Insulin Administration ◽  
Patient Interactions ◽  
Patients With Diabetes ◽  
Glycemic Management

Abstract The pandemic of COVID-19 has presented new challenges to hospital personnel providing care for infected patients with diabetes who represent more than 20% of critically ill patients in intensive care units. Appropriate glycemic management contributes to a reduction in adverse clinical outcomes in acute illness but also requires intensive patient interactions for bedside glucose monitoring, intravenous and subcutaneous insulin administration, as well as rapid intervention for hypoglycemia events. These tasks are required at a time when minimizing patient interactions is recommended as a way of avoiding prolonged exposure to COVID-19 by health care personnel who often practice in settings with limited supplies of personal protective equipment. The purpose of this manuscript is to provide guidance for clinicians for reconciling recommended standards of care for infected hospitalized patients with diabetes while also addressing the daily realities of an overwhelmed health care system in many areas of the country. The use of modified protocols for insulin administration, bedside glucose monitoring, and medications such as glucocorticoids and hydroxychloroquine that may affect glycemic control are discussed. Continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but there are important issues that need to be addressed if these are used in hospitalized patients. On-site and remote glucose management teams have potential to provide guidance in areas where there are shortages of personnel who have expertise in inpatient glycemic management.

scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Hospitalized Patients ◽  
Matched Pair ◽  
Patients With Diabetes ◽  
Clarke Error Grid ◽  
Error Grid

<b>Background: </b>Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational with limited data on its accuracy in the hospital setting. <p><b>Methods: </b>To analyze the accuracy of Dexcom G6 CGM,<b> </b>we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within ±15, 20 and 30% or ±15, 20 and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (?/15, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses.</p> <p><b>Results: </b>A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL).</p> <p><b>Conclusion: </b>Our results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes. </p>

scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Hospitalized Patients ◽  
Matched Pair ◽  
Patients With Diabetes ◽  
Clarke Error Grid ◽  
Error Grid

<b>Background: </b>Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational with limited data on its accuracy in the hospital setting. <p><b>Methods: </b>To analyze the accuracy of Dexcom G6 CGM,<b> </b>we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within ±15, 20 and 30% or ±15, 20 and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (?/15, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses.</p> <p><b>Results: </b>A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL).</p> <p><b>Conclusion: </b>Our results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes. </p>

scholarly journals Future Perspectives in Glucose Monitoring Sensors

2013 ◽  
Vol 09 (01) ◽  
pp. 21 ◽  
Author(s):  
Giulio Frontino ◽  
Franco Meschi ◽  
Riccardo Bonfanti ◽  
Andrea Rigamonti ◽  
Roseila Battaglino ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Patient Compliance ◽  
Glucose Control ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Blood Glucose Monitoring ◽  
Patients With Diabetes ◽  
Almost All ◽  
Monitoring Devices

The prevalence of diabetes is increasing. Improved glucose control is fundamental to reduce both long-term micro- and macrovascular complications and short-term complications, such as diabetic ketoacidosis and severe hypoglycemia. Frequent blood glucose monitoring is an essential part of diabetes management. However, almost all available blood glucose monitoring devices are invasive. This determines a reduced patient compliance, which in turn reflects negatively on glucose control. Therefore, there is a need to develop noninvasive glucose monitoring devices that will reduce the need of invasive procedures, thus increasing patient compliance and consequently improving quality of life and health of patients with diabetes.

Tackling diabetes management in patients with dementia: the use of continuous glucose monitoring

2020 ◽  
Vol 22 (1) ◽  
pp. 38-42
Author(s):  
Sarah Jane Palmer
Keyword(s):  
Disease Management ◽  
Continuous Glucose Monitoring ◽  
Older Patients ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Potential Solution ◽  
Patients With Diabetes ◽  
Future Care ◽  
Positive Results

A study analysing the use of continuous glucose monitoring through sensors in older patients with diabetes and dementia has produced positive results, providing a potential solution for future care and disease management. Sarah Jane Palmer explains

Continuous glucose monitoring: data management and evaluation by patients and health care professionals – current situation and developments

2018 ◽  
Vol 42 (6) ◽  
pp. 225-233
Author(s):  
Guido Freckmann ◽  
Jochen Mende
Keyword(s):  
Health Care ◽  
Continuous Glucose Monitoring ◽  
Health Care Professionals ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Diabetic Patients ◽  
Diabetes Therapy ◽  
Software Applications ◽  
Metabolic States ◽  
Specific Device

Abstract Continuous glucose monitoring (CGM) technology represents a valuable tool for diabetic patients to control and regulate their blood glucose (BG) levels and to reduce adverse metabolic states, for example, by defining glucose alarm thresholds that alert users if the glucose value crosses to an undesired range. Improvement of CGM technology is ongoing, but there are barriers which confine the usefulness of CGM systems. The utility is mainly defined by the operability of the specific device and also by the provided benefit of available CGM software solutions. In order to take best advantage of diabetes therapy, users should be adequately educated in how to use their CGM system and how to interpret the collected data. Different CGM software applications provide partially different CGM reports and statistics. The standardization of this information also would be conducive to the best possible diabetes management.

scholarly journals MON-664 Are Hospitals Doing Enough in Caring for Patients with Diabetes?Results of a Landmark Survey: Current State of Inpatient Diabetes Care and Glycemic Management

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Andrew S Rhinehart ◽  
Melanie Mabrey ◽  
Valerie Garrett
Keyword(s):  
Glycemic Control ◽  
Medication Errors ◽  
Diabetes Care ◽  
Online Survey ◽  
High Reliability ◽  
Hospitalized Patients ◽  
Patients With Diabetes ◽  
Sliding Scale ◽  
Basal Bolus ◽  
Glycemic Management

Abstract BACKGROUND On average, 1 of every 3 hospitalized patients — the majority with diabetes — requires insulin to control blood glucose during their stay. Although widely prescribed and absolutely necessary, insulin is inherently dangerous: 50% of all medication errors involve insulin, including 1/3 of all fatal medication errors. Results of a nationwide survey indicate that prioritization of glycemic control is lacking, which hinders high reliability and increases risk of morbidity and mortality. METHODS Healthcare professionals who serve in roles involving diabetes care and glycemic management were invited to participate in an online survey. To qualify, an initial question that read: “Where do you work?” had to be answered “hospital or health system with focus on inpatients” (those who answered “physician’s office or clinic with focus on outpatients” were disqualified). There were a total of 619 respondents from 408 U.S. hospitals. KEY RESULTS • The consensus among respondents is that fear of hypoglycemia has a strong influence on the prescribing of insulin (i.e., causes non-prescribing or lack of intensification following hyperglycemia). On a scale of 1 to 5, with 1 being ‘very little if any influence’ and 5 being ‘considerable influence,’ the average weighted score was 3.45. • About 70% of respondents are of the opinion glycemic control is ‘extremely important’ or ‘very important’ to nurses and physicians, whereas about 48% believe this to be true of senior clinical executives and 25% believe this to be true of non-clinical senior executives. • Only 24% of respondents maintain their hospital uses primarily basal bolus for subcutaneous insulin therapy. Close to 34% maintain their hospital uses primarily sliding scale and 42% maintain their hospital uses sliding scale and basal bolus equally as often. The top three barriers to full adoption of basal bolus insulin are: (1) inadequate prescriber knowledge about basal-bolus-correction regimens, (2) beliefs that sliding scale is acceptable practice and not harmful, and (3) difficulties coordinating glucose monitoring, insulin administration and meal delivery. • Slightly more than 2/3 of respondents work at a hospital that routinely tracks and reports the rate of hypoglycemia (on a monthly or quarterly basis). Of those, 54% use a threshold of 60 and/or 70 mg/dL exclusively, which encompasses all episodes of hypoglycemia without accounting for severity; only 24% use thresholds of 60 and/or 70 mg/dL as well as thresholds of 40, 50 and/or 54 mg/dL, allowing episodes of greater severity to be isolated for analysis and quality improvement. CONCLUSION Results of the survey indicate better care, specifically better glycemic control, is needed for hospitalized patients with diabetes. With the shift from volume to value and a stronger focus on quality and safety, this data should be catalyst for making glycemic control a strategic imperative.

scholarly journals Progress of the patients with diabetes mellitus who were managed with the staged diabetes management framework

2007 ◽  
Vol 20 (3) ◽  
pp. 338-344 ◽  
Author(s):  
Maria Lúcia Zanetti ◽  
Liudmila Miyar Otero ◽  
Denise Siqueira Peres ◽  
Manoel Antônio dos Santos ◽  
Fernanda Pontin de Mattos Guimarães ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Diabetes Management ◽  
Health Care Team ◽  
Physical Activities ◽  
Team Members ◽  
Management Framework ◽  
Adherence To Diet ◽  
Study Results ◽  
Patients With Diabetes

OBJECTIVE: To describe the progress of patients with diabetes mellitus seen by health care team members who followed the Staged Diabetes Management framework. METHODS: This descriptive, prospective, and longitudinal study was conducted in a period of 12 months. The sample consisted of 54 patients with diabetes mellitus. Data were collected in three occasions through interviews: P0 - at beginning of the study; P6 - in six months; and, P12 - at the end of the study. RESULTS: There was an increase in adherence to diet from 61.1% in the P0 to 92.6% in the P12, in adherence to physical activities from 57.4% in the P0 to 66,7% in the P12, and in the use of medication. CONCLUSION: The use of the SDM framework among this sample of patients with diabetes promoted better adherence to diet, physical activities, and the use of medication.

scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

Diabetes Care ◽  
2021 ◽  
pp. dc202856
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Patients With Diabetes
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