Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Abstract

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.

Keywords: COVID-19; automated insulin dosing; continuous glucose monitor; guideline; hospital.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RJG is supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institute of Health under Award Number 1K23DK123384-01 and P30DK11102. RJG received research support (to Emory University) for investigator-initiated studies from Novo Nordisk and Dexcom, and consulting fees from Abbott Diabetes Care, Eli Lilly, Sanofi, Novo Nordisk, and Valeritas. GEU is partly supported by research grants from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 from the Clinical and Translational Science Award program and a National Institutes of Health (NIH) grant U30, P30DK11102, and has received research grant support to Emory University for investigator-initiated studies from Sanofi, Novo Nordisk, and Dexcom. AB received grant support through NIDDK 085516 and 106785. JHN received research grant support and professional speaking honoraria from Abbott and Roche Diagnostics. EKS was partially supported by the VA MERIT award (#1I01CX001825) from the United States Department of Veterans Affairs Clinical Sciences Research and Development Service. EKS has received unrestricted research support from Dexcom (to Baltimore VA Medical Center and to University of Maryland) for the conduction of clinical trials. JE’s efforts were supported by the Food and Drug Administration under award number P50FD006425 for The West Coast Consortium for Technology & Innovation in Pediatrics. The funding source had no involvement in the development of this manuscript or in the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the FDA. BB is on medical advisory boards for Convatec, Medtronic, and Tolerion. GF is general manager and medical director of the Insitute for Diabetes Technology (Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany), which carries out clinical studies on the evaluation of BG meters, with CGM systems and medical devices for diabetes therapy on its own initiative and on behalf of various companies. GF has received speakers’ honoraria or consulting fees from Abbott, Ascensia, Dexcom, i-SENS, LifeScan, Menarini Diagnostics, Metronom Health, Novo Nordisk, PharmaSense, Roche, Sanofi, Sensile, and Ypsomed. RH reports having received speaker honoraria from Eli Lilly and Novo Nordisk, serving on advisory panel for Eli Lilly and Novo Nordisk; receiving license fees from BBraun and Medtronic; having served as a consultant to BBraun, patents related to closed-loop insulin delivery, and director at CamDiab. DNO has served on advisory boards for Abbott, Medtronic, MSD, Novo, Roche, and Sanofi; received research support from Medtronic, Novo, Roche, Lilly, and Sanofi; and travel support from Novo and MSD. AW received research support from United Health Group and Eli Lilly, and received research funding from Novo Nordisk. DCK is a consultant to Dexcom, Eoflow, Fractyl, Lifecare, Novo Nordisk, Roche Diagnostics, and Thirdwayv. RJR, SL, NEP, DGA, LB, CBC, LH, NM, TN, MR, DBS, JJS, TS, JYZ, and JH have nothing to disclose.

Figures

Figure 1.

Continuous glucose monitors or automated insulin dosing system sample patient agreement. CGM, continuous glucose monitoring; CT, computed tomography; MRI, magnetic resonance imaging.