Glucose as the Fifth Vital Sign: A Randomized Controlled Trial of Continuous
Poor glucose monitoring of inpatients in a non-ICU Hospital setting is common. It contributes to increased morbidity, mortality, and health care cost. Continuous glucose monitoring (CGM) has a larger potential to detect hyperglycemia or hypoglycemia in the hospital as compared to point-of-care (POC) testing. However, there is less real-time evidence to guide the implementation of CGM in a hospital environment. The author Fortmann and colleagues (2020) conducted a randomized control trial titled “Glucose as the Fifth Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a Non-ICU Hospital Setting” published in the Diabetes Care journal. A summary of the findings is given below:
Objectives:
To provide comparative evidence for real-time CGM and POC testing in a non–intensive care unit (ICU) hospital setting.
Method:
Participants included 110 adults with type-2 diabetes (T2D). On a non- ICU floor, these participants received RT-CGM with Dexcom G6 as compared to usual care (UC). The glucose levels are being updated to bedside nursing by hospital telemetry after monitoring RT-CGM wirelessly transmitted data. Standardized protocols were used for interventions.
Findings:
The study reports that RT-CGM along with standardized protocols improved mean glucose, time in range (TIR), hyperglycemia without increasing the number of events of hypoglycemia per person in patients with T2D. As the demand for safe methods to monitor glucose has increased during the covid-19 pandemic, CGM was found to be a valuable device in the non-ICU environment. While the use of CGM can be expensive, it can also be cost-effective when continued in the post-discharge period. This will help to prevent readmission which is common in diabetes patients. Investigators also add that a dedicated diabetes team and education of frontline staff is important for successful administration of CGM. Maintaining metabolic and glucose equilibrium helps in maintaining the state of a body’s essential function. Hence, CGM can truly be the fifth vital sign.
Limitations:
Although the device was well tolerated by patients without complaints, there are restrictions on allowing transmitters on during procedures such as MRI, computed tomography, etc. Authors acknowledge future researches to study if these procedures can be performed with the transmitter on. Future studies with higher thresholds as compared to those used in this study for nurse notification should be used to improve the prevention of hypoglycemic events. Patients with a higher risk of hypoglycemic events should be included in the future.
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