Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA.
Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University, Stanford, CA.
Diabetes Care. 2024 Oct 1;47(10):1838-1845. doi: 10.2337/dc24-0626.
We aimed to assess the feasibility, clinical accuracy, and acceptance of a hospital-wide continuous glucose monitoring (CGM) policy with electronic health record (EHR)-integrated validation for insulin dosing.
A hospital policy was developed and implemented at Stanford Health Care for using personal CGMs in lieu of fingerstick blood glucose (FSBG) monitoring. It included requirements specific to each CGM, accuracy monitoring protocols, and EHR integration. User experience surveys were conducted among a subset of patients and nurses.
From November 2022 to August 2023, 135 patients used the CGM protocol in 185 inpatient encounters. This group included 27% with type 1 diabetes and 24% with automated insulin delivery systems. The most-used CGMs were Dexcom G6 (44%) and FreeStyle Libre 2 (43%). Of 1,506 CGM validation attempts, 87.8% met the 20% or 20 mg/dL (%20/20) criterion for CGM-based insulin dosing and 99.3% fell within Clarke zones A or B. User experience surveys were completed by 27 nurses and 46 patients. Most nurses found glucose management under the protocol effective (74%), easy to use (67%), and efficient (63%); 80% of nurses preferred inpatient CGM to FSBG. Most patients liked the CGM protocol (63%), reported positive CGM interactions with nursing staff (63%), and felt no significant interruptions to their diabetes management (63%).
Implementation of a hospital-wide inpatient CGM policy supporting multiple CGM types with real-time accuracy monitoring and integration into the EHR is feasible. Initial feedback from nurses and patients was favorable, and further investigation toward broader use and sustainability is needed.
我们旨在评估在斯坦福健康医疗中心实施全院范围的连续血糖监测（CGM）政策的可行性、临床准确性和接受程度，该政策通过电子健康记录（EHR）整合了胰岛素剂量调整的验证。
斯坦福健康医疗中心制定并实施了一项政策，允许在医院内使用个人 CGM 替代指尖血糖（FSBG）监测。该政策包括对每个 CGM 的具体要求、准确性监测方案以及 EHR 整合。我们对一小部分患者和护士进行了用户体验调查。
从 2022 年 11 月到 2023 年 8 月，135 名患者在 185 次住院期间使用了 CGM 方案。该组患者包括 27%的 1 型糖尿病患者和 24%的自动化胰岛素输送系统患者。最常用的 CGM 是 Dexcom G6（44%）和 FreeStyle Libre 2（43%）。在 1506 次 CGM 验证尝试中，87.8%符合基于 CGM 的胰岛素剂量调整的 20%或 20 毫克/分升（%20/20）标准，99.3%落在 Clarke 区 A 或 B 内。27 名护士和 46 名患者完成了用户体验调查。大多数护士认为该协议下的血糖管理有效（74%）、易于使用（67%）且高效（63%）；80%的护士更喜欢在医院内使用 CGM 而不是 FSBG。大多数患者喜欢 CGM 方案（63%），报告说与护理人员的 CGM 交互积极（63%），并且没有对他们的糖尿病管理造成显著干扰（63%）。
在斯坦福健康医疗中心实施全院范围的住院 CGM 政策是可行的，该政策支持多种 CGM 类型，具有实时准确性监测，并整合到 EHR 中。来自护士和患者的初步反馈是积极的，需要进一步调查以实现更广泛的使用和可持续性。
