The COVID-19 pandemic necessitated the use of technology in outpatient settings around the world, but it also served as a catalyst for the expanded use of technology in inpatient settings, according to Amisha Wallia, MD, MS.
“The (diabetes) epidemic met a pandemic,” said Dr. Wallia, Division of Endocrinology, Metabolism, and Molecular Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine. “We know there are so many people who are getting suboptimal care in terms of diabetes—inpatient and outpatient—because we can’t reach them all. We really need to use technology as a base.”
Dr. Wallia is one of five presenters who shared their firsthand experiences with inpatient technology during the symposium Automation and Expanded Use of Technology in the Inpatient Setting—An Update. The session, which was originally presented Monday, June 28, can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.
Robert J. Rushakoff, MD, Professor of Medicine, University of California, San Francisco (UCSF), discussed the virtual glucose management service (vGMS) in use at UCSF. The automated service tracks daily reports of patients who have hyperglycemic or hypoglycemic readings, are using a pump, or have type 1 diabetes. If the service determines additional care may be warranted, it opens a consultation note in the electronic medical record so a physician can review the information and change orders if necessary.
Since its introduction, vGMS has resulted in a 39% decrease in patients on the daily hyperglycemia list, a 38% decrease in glucose measurements less than 70 mg/dL, and a 64% decrease in glucose levels less than 40 mg/dL, Dr. Rushakoff said.
Addie L. Fortmann, PhD, Scripps Whittier Diabetes Institute, Scripps Health, described a randomized clinical trial conducted by Scripps Health prior to COVID-19 that compared inpatient use of continuous glucose monitoring (CGM) to point-of-care (POC) testing in the hospital. The outcome wasn’t statistically powered, but there was a statistically significant benefit in the CGM group for time-in-range (70 mg/dL to 250 mg/dL), and the CGM group also achieved 18.5 mg/dL lower mean glucose and spent less time above 250 mg/dL.
“Knowing that glucose is being monitored around the clock (in an inpatient setting) can be comforting, especially for somebody who uses CGM in the outpatient setting,” Dr. Fortmann said. “And, of course, this limits the number of times the nurse needs to enter the room to obtain a point-of-care value.”
David C. Klonoff, MD, Medical Director, Diabetes Research Institute, Mills-Peninsula Medical Center, and Clinical Professor of Medicine, UCSF, predicted that CGM will become widely adopted in hospital wards even before it is widely adopted in the intensive care unit (ICU). Ward patients are usually evaluated every four hours, much less often than in the ICU, where hypoglycemia symptoms and falling blood glucose will be noticed, he said.
Between 7% and 17% of hospital patients have a hypoglycemic episode, Dr. Klonoff added, and each episode costs $12,000, adds an average of 4.1 days to a hospital stay, and brings a 2.2 times greater risk of death. CGM in the hospital setting can help prevent this complication.
“Continuous glucose monitoring will eventually become a routine tool to automatically monitor all hospital patients,” he said.
Joseph A. Aloi, MD, FACE, FACP, Chief of Endocrinology, Diabetes and Metabolism Division, Wake Forest School of Medicine, discussed inpatient use of hybrid closed-loop (HCL) systems.
“I think we’ve come a long way as we’ve introduced technology with CGM in the hospital in that people don’t automatically take off pumps, V-Go®, and CGMs as the patient comes in, and more often are leaving patients with their devices until they contact glucose management or endocrine,” Dr. Aloi said.
The nursing staff has been a big advocate for these devices because they’ve seen the bedside benefit for patients who are able to self-manage, Dr. Aloi said. But it’s important to proactively develop policies and procedures to govern HCL use, he noted.