Continuous Glucose Monitors Come to Hospitals

Continuous glucose monitors (CGMs) could enhance care of hospitalized people with diabetes, supplementing or possibly even replacing the use of finger sticks to draw blood to measure a patient’s glucose level. But that technological future will require ensuring that the monitoring devices are as accurate as the conventional method, experts told Medscape Medical News.

In 2020, the US Food and Drug Administration (FDA) enabled in-hospital use of CGMs to reduce contact between patients and healthcare providers during the COVID-19 pandemic. Diabetes is a risk factor for more severe COVID, meaning that many patients with the infection also required ongoing care for their blood sugar problems. 

Prior to the pandemic, in-person finger-stick tests were the primary means of measuring glucose for hospitalized patients with diabetes.

The trouble is that finger-stick measurements quickly become inaccurate.

Eileen Faulds, RN, PhD, reviews blood sugar readings from a patient with a continuous glucose monitor.

“Glucose is a measurement that changes pretty rapidly,” said Eileen Faulds, RN, PhD, an endocrinology nurse and health services researcher at The Ohio State University, in Columbus. Finger sticks might occur only four or five days per day, Faulds noted, or as often as every hour for people who receive insulin intravenously. But even that more frequent pace is far from continuous.

“With CGM we can get the glucose level in real time,” Faulds said. 

Faulds is lead author of a new study in the Journal of Diabetes Science and Technology showing that nurses in the ICU believe that using continuous monitors, subcutaneous filaments connected to sensors that regularly report glucose levels, enables better patient care than does relying on periodic glucose tests alone. Nurses still used traditional finger sticks, which Faulds notes are highly accurate at the time of the reading.

In a 2022 study, glucose levels generated by CGM and those measured by finger sticks varied by up to 14%. A hybrid care model combining CGMs and finger stick tests may emerge, Faulds said.

A Gusher of Glucose Data

People with diabetes have long been able to use CGMs in their daily lives, which typically report the glucose value to a smartphone or watch. The devices are now part of hospital care as well. In 2022, the FDA granted a breakthrough therapy designation to the company Dexcom for use of its CGMs to manage care of people with diabetes in hospitals.

One open question is how often CGMs should report glucose readings for optimum patient health. Dexcom’s G6 CGM reports glucose levels every five minutes, for example, whereas Abbott’s FreeStyle Libre 2 delivers glucose values every minute. 

Lizda Guerrero-Arroyo, MD

“We wouldn’t look at each value, we would look at the big picture,” to determine if a patient is at risk of becoming hyper- or hypoglycemic, said Lizda Guerrero-Arroyo, MD, a postdoctoral fellow in endocrinology at the Emory University School of Medicine, in Atlanta. Guerrero-Arroyo recently reported that clinicians in multiple ICUs began to use CGMs in conjunction with finger sticks during the pandemic, and felt the devices could reduce patient discomfort. 

“A finger stick is very painful,” Guerrero-Arroyo said, and a bottleneck for nursing staff who administer these tests. In contrast, Faulds said, CGM placement is essentially painless and requires less labor on the ward to manage.

Beyond use in the ICU, clinicians are also experimenting with use of CGMs to monitor blood sugar levels in people with diabetes who are undergoing general surgery. And other researchers are describing how to integrate data from CGMs into patient care tools such as the electronic health record, although a standard way to do this does not yet exist.

Samantha Spierling Bagsic, PhD

Assuming CGMs remain part of the mix for in-hospital care of people with diabetes, clinicians may mainly need trend summaries of how glucose levels rise and fall over time, said data scientist Samantha Spierling Bagsic, PhD, of the Scripps Whittier Diabetes Institute in San Diego, California. Guerrero-Arroyo said that she shares that vision. But a minute-by-minute analysis of glucose levels also may be necessary to get a granular sense of how changing a patient’s insulin level affects their blood sugar, Spierling Bagsic said.

“We need to figure out what data different audiences need, how often we need to measure glucose, and how to present that information to different audiences in different ways,” said Spierling Bagsic, a co-author of the study about integrating CGM data into patient care tools.

The wider use of CGMs in hospitals may be one silver lining of the COVID-19 pandemic. As an inpatient endocrinology nurse, Faulds said that she wanted to use CGMs prior to the outbreak, but at that point, a critical mass of studies about their benefits was missing.

“We all know the terrible things that happened during the pandemic,” Faulds said. “But it gave us the allowance to use CGMs, and we saw that nurses loved them.”

Faulds reports relationships with Dexcom and Insulet and has received an honorarium from Medscape. Guerrero-Arroyo, MD, and Bagsic reported no financial conflicts of interest.

Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

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