This NIH review, published in January 2021, examines in-patient use of insulin pumps and CGMs (continuous glucose monitors) in the hospital setting. From this patient’s point of view, hospitals and medical professionals have been slow to formally address the diabetes tech that we patients use every day.
Many of us find this technology contributes greatly to our quality of life and can’t imagine going without it if we enter the hospital. Of course, there are good reasons why disconnecting our pumps and CGMs can be entirely appropriate. But there are also many circumstances where staying connected can help the patient and hospital staff while also producing a better health outcome.
I found this review to be up-to-the-minute and comprehensive in its coverage. If you like reading diabetes studies then you’ll likely find this review interesting.
These ground rules are found in the On Admission section:
Patients should not make changes to their pump settings without first discussing with hospital staff [6]. If possible, the target glucose set within the pump should be adjusted to 140–180 mg/dL, as per ADA guidelines for critically ill and non-critically ill hospitalized patients with diabetes [1]. Patients should be made aware of these targets, as it likely differs from outpatient goals [6]. If hospital policy dictates a signed patient agreement, the agreement should delineate the responsibilities of the patient to manage their device and include consent to share pump settings and information with hospital staff and to report any issues [2, 3, 9].
Agreeing to target 140-180 mg/dL does give me pause. I have strong opinions about this but I’ll save them for the comments.
It appears that Covid-19 has forced the issue of diabetes tech in the hospital. Historically, human institutions resist change. Many of us who have spent time in the hospital have been alarmed by how much medical professionals don’t know about diabetes. This doesn’t apply to all hospital staff but, in general, diabetes knowledge is deficient. Let’s hope that the exposure gained by Covid ICU staff with CGMs can create a more general acceptance of this tech in the hospital setting.