b'In-hospital Continuous Glucose Monitoring Protects Patients, Healthcare ProvidersHyperglycemia and diabetes are common in hospitalized patients. Managing that amid the restrictions of the COVID-19 pandemic, including rampant staff shortages, has been extremely difficult at the VA and elsewhere. Increased use of continuous glucose monitoring has helped the situation.By Annette M. BoyleBALTIMOREDiabetessignificantlyincreasescontinuingtheuseofCGMsinhospitals. 1 As theriskofseverecomplicationsassociatedwithapproximatelyone-thirdofhospitalpatientshave COVID-19, making particularly important the care- diabetes or hyperglycemia, even outside of the pan-fulmonitoringofhospitalizedpatientswiththedemic,adoptionofCGMsintheinpatientsetting condition. could have significant effects on hospital policy and At the same time, shortages of personal protectiveuse of staff. 2equipmentearlyinthepandemicandadearthofTheteam,ledbyEliasSpanakis,MD,ofthe nurses and other healthcare workers in more-recentBaltimore VAMC and the University of Maryland, waves have made traditional in-person fingersticksevaluated the research on in-hospital use of CGMs and paper-based systems for guiding insulin dripsusing a wide range of metrics and found the use untenable in many situations. of inpatient CGM confers numerous benefits with Increasingly,too,patientswithdiabeteshaveminimal risks.arrivedatthehospitalwiththeirowncontinuousThe devices reduced the incidence of hypoglyce-glucose monitors in place. Globally, the continuousmia and improved management of hyperglycemia. glucose monitoring (CGM) system market is antici- In one study, patients using CGM with a glucose pated to more than quadruple from $4.31 billion attelemetry system (GTS) that transmitted data from the start of the pandemic in 2020 to $17.8 billion bythe patients sensor to an iPhone and then to an iPad 2028, according to Emergen Research. at the nursing station had fewer hypoglycemic events CGM growth continues to be driven by the increas- calculated as blood glucose below 70 mg/dL (0.67 ingprevalenceofType2diabetes,risingobesity[95%confidenceinterval,CI0.341.30]vs.1.69 rates and an aging population, along with strong evi- [1.112.58], P=0.024) and fewer clinically signifi-dence supporingt the use of CGM to manage diabe- cant hypoglycemic events or blood glucose below tes in the ambulatory setting. In 2020, the U.S. Food54mg/dL(0.08[0.030.26]vs.0.75[0.511.09], andDrug AdministrationrelaxedrulesgoverningP=0.003) compared to patients whose blood glucose the use of CGMs, permitting deployment of Abbottwas measured at point of care. and Dexcom CGMs in the inpatient setting during the pandemic. In March 2022, the FDA granted theLess Hyperglycemiafirst CGM breakthrough device designation for useAnother study determined that real time-CGM also in hospitals. reduced the percentage of time spent in hyperglyce-Arecentmeta-analysisbyresearchersatthemia compared to usual care, 27% vs. 33%. A third Baltimore VAMC and the University of Marylandfound that use of CGM significantly increased the SchoolofMedicineprovidesstrongsupportfortimeinrangeforpatientswithType2diabetes, Continued on Page 20 u18'