For a study published in Diabetes Care, Elias K. Spanakis, MD, and colleagues evaluated the use of glucose telemetry in hospitalized patients with diabetes. “This system is based on real-time continuous glucose monitoring (RT-CGM) devices that can measure blood glucose values every 5 minutes,” Dr. Spanakis says. “Glucose telemetry utilizes wireless transmission of glucose values, in real time, from the CGM device directly to the nursing station, similar to cardiac telemetry. The system uses a bedside smartphone that communicates with a tablet at the nursing station.”

System Helps Reduce COVID-19 Exposure Risk

Compared with traditional fingerstick glucose testing, glucose telemetry has many benefits, Dr. Spanakis explains. “It provides clinically useful data from CGM every 5 minutes,” he says. “Nursing staff have immediate access to these blood glucose values and can make informed decisions in patient management. Also, CGMs trigger an alarm when blood glucose levels are low or high, and as a result, nurses and physicians can be instantly notified about hypoglycemia or severe hyperglycemia. Plus, during the COVID-19 pandemic, real-time CGM and glucose telemetry can be used to replace fingerstick testing as a method of glucose monitoring, decreasing the need for frequent entry of nursing staff into patient rooms. This reduces risk of COVID-19 exposure and the need for personal protective equipment use.”

Although Dr. Spanakis and colleagues reported the effectiveness of RT-CGM devices used in a hospital setting in a previously published case report of a patient with severe hypoglycemia who was unable to report symptoms due to impaired mental status, they also identified barriers to expanding their use. “Initial RT-CGM devices had to be in the patient’s room, and nurses had to enter the room frequently in order to check glucose values, which was not practical,” he notes. “Therefore, we developed the glucose telemetry system, which allows the wireless transmission of glucose values directly to the nursing station, making them readily accessible. We also set low blood glucose alarms at 85 mg/dL and instructed nursing staff to initiate preventive actions/treatment when glucose fell below that level. Our study showed that glucose telemetry can prevent hypoglycemia in the hospital.”

Preventing Hypoglycemia Without Creating Hyperglycemia

By setting the alarms at 85 mg/dL, the researchers were not only effective at preventing hypoglycemia, but did so without creating hyperglycemia. “Using alarms at higher settings, such as 100 mg/dL, will definitely decrease hypoglycemia, but there are concerns—although unproven—that it may worsen hyperglycemia,” he says.

Dr. Spanakis notes that the RT-CGM/glucose telemetry system (GTS) group had a reduction in hypoglycemic events per patient at either less than 70 mg/dL (0.67 vs 1.69) or less than 54 mg/dL (0.08 vs. 0.75), when compared with the fingerstick group (Table). Time below range (TBR) of either less than 70 mg/dL (0.40% vs. 1.88%) or less than 54 mg/dL (0.05% vs. 0.82%) was also reduced in the RT-CGM/GTS group. “We showed that the proposed intervention—RT-CGM-GTS combined with a simplified hypoglycemia prevention protocol—can be effective in reducing hypoglycemia,” he concludes. “We expect that in the future, CGM systems might be utilized to monitor high-risk individuals with diabetes, similar to how we use cardiac telemetry among high-risk patients with arrhythmia.”

No between-group differences were observed in the study in nocturnal hypoglycemia, time in range 70-180 mg/dL, or time above range of 180-250 mg/dL or greater than 250 mg/dL. Prolonged hypoglycemia was not experienced by the RT-CGM/GTS group, whereas the fingerstick group experienced 0.20 episodes at less than 54 mg/dL per patient and 0.40 episodes at less than 70 mg/dL per patient.

Dr. Spanakis would like to see additional studies that will show that CGM systems in the hospital can improve not only glucose control, but also important clinical outcomes. “These studies will be extremely helpful in supporting wide use of real-time CGM systems in the hospital setting,” he says. In the meantime, he takes solace in the study’s finding that “RT-CGM/GTS can decrease hypoglycemia among hospitalized, high-risk, insulin-treated patients with type 2 diabetes. In addition, these devices can prevent hypoglycemia in a more cost-effective manner, without having a nurse assigned to constantly monitor glucose values.”

Disclaimer: The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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