CGM may be ‘potential solution’ as standard of care in hospitals

Key takeaways:

CGM conferred higher time in range for hospitalized patients at The Ohio State University vs. historical controls.
The institution is implementing CGM as standard of care in the ICU beginning in November.

Continuous glucose monitoring can be implemented in the ICU, providing glycemic benefits along with cost savings and increased satisfaction among nurses, according to a presenter.

In 2020, U.S. health systems were able to use CGM during inpatient hospitalization of patients with COVID-19 under emergency use authorization from the FDA. In May 2020, healthcare professionals at The Ohio State University (OSU) Wexner Medical Center began using CGM for their patients, according to Eileen R. Faulds, PhD, MS, RN, FNP-BC, assistant professor at the Center for Healthy Aging, Self-Management and Complex Care at the OSU Wexner Medical Center. This CGM use led to the institution conducting an implementation effectiveness trial examining the efficacy of the devices in the ICU. During a presentation at the Association of Diabetes Care & Education Specialists annual meeting, Faulds presented data from the trial and explained how the study is leading the hospital to implement CGM as standard of care in the near future.

“Inpatient glucose management is not being done well [in the hospital]and it is having dire consequences,” Faulds said during a presentation. “For a long time, the use of CGM has been thought of as a potential solution to improve glucose control in the hospital setting.”

Trial findings

Researchers at OSU recruited 100 hospitalized patients admitted to the ICU to use a Dexcom G6 hybrid CGM from August 2022 to October 2024 (47% women; mean age, 54.6 years). Point-of-care validation from nursing staff took place every 4 hours. Data from the patients using CGM were compared with a group of historical controls who did not use CGM (53% women; mean age, 52.7 years).

“We looked at not only [whether] CGM improved glycemic control, but we also looked at [whether] nurses can use it effectively,” Faulds said. “Are they following protocol? Are they able to insert the devices? What does it look like for their workload? What’s the economic impact of using CGM in the hospital?”

The CGM group had a higher time in range with glucose between 70 mg/dL and 180 mg/dL compared with controls (76% vs. 64%; estimated difference, 11.7 percentage points; 95% CI, 6.2-17.3; P < .01). Time spent in hyperglycemia with glucose of more than 250 mg/dL (6% vs. 17%; P < .01) or more than 300 mg/dL (2.7% vs. 11.3%; P < .01) was lower for adults receiving a CGM compared with controls. The CGM group also had higher time in tight range with glucose between 100 mg/dL and 180 mg/dL or glucose between 140 mg/dL and 180 mg/dL than controls.

All the CGM had low hypoglycemia alerts set for less than 100 mg/dL. Faulds said according to manufacturer settings, urgent low soon alarms occurred when glucose of less than 55 mg/dL was predicted within 20 minutes, and an urgent low alarm took place when glucose reached less than 55 mg/dL.

During the trial, 1,061 alerts occurred for an average of 3.6 signals per patient-day. Of the alerts, 77% were for low glucose of less than 100 mg/dL. Of urgent low alarms, 95% were preceded by an urgent low soon alarm. A mean 10 minutes of advance warning time was given before a patient had an urgent low alarm, and 35% of patients with an urgent low soon alarm had confirmatory point-of-care hypoglycemia within 20 minutes.

Faulds said the institution later set the low hypoglycemia alerts to 80 mg/dL based on the trial findings.

“We found that 51% of alarm events contained glucose [measures] where the glucose was between 80 mg/dL and 100 mg/dL and never went below 80 mg/dL,” Faulds said. “When we looked at that, we [said] we have some room for improvement here. We don’t need to be sending nurses a bunch of alarms for glucoses that are between 80 mg/dL and 100 mg/dL, which are normal for a lot of patients.”

Researchers also conducted a time in motion study where nursing time with CGM was compared with point-of-care monitoring. In an analysis of 20 4-hour observations, using CGM resulted in 35 minutes of nursing time saved compared with point-of-care glucose monitoring.

Researchers also estimated the economic impact of CGM use. They compared hybrid CGM use with validation every 4 hours, CGM use with validation every 6 hours, and nonadjunctive CGM use to point-of-care testing with no CGM using estimated costs of supplies, devices and nursing salary and benefits. Compared with point-of-care testing with no CGM, using a CGM with validation every 4 hours could save a hospital $16.01 per patient-day, using CGM with validation every 6 hours would save $19.41 per patient-day, and nonadjunctive CGM use could save a hospital $26.14 per patient-day.

“There’s a huge cost benefit that we’re able to see using CGM vs. point-of-care testing for patients on intravenous insulin in the hospital,” Faulds said.

OSU also partnered with Emory University for a study on nursing workload with CGM use in the ICU. In the study of 70 nurses, which was published in the Journal of Diabetes Science and Technology in 2023, 92% of participants said CGM reduced workload, 93% stated CGM reduced the number of room entries, 93% preferred CGM to point-of-care testing and 97% said they wanted to continue using CGM.

Real-world implementation

Based on the findings of the trial, the OSU Wexner Medical Center opted to change its internal clinical practice guidelines to make CGM standard of care in the ICU, Faulds said. The new guideline was approved in early 2025, but the process was stopped shortly thereafter when changes to the COVID-19 emergency use authorization led to CGM no longer being covered for use in hospitals, meaning CGM would have to be used off-label. However, after receiving legal clearance and approval from multiple committees, Faulds said the hospital plans to make CGM standard of care, with a target goal of implementing the new guidance in November.

“Ohio State University, to the best of my knowledge, is the first health system in the U.S. to approve CGM completely off-label,” Faulds said.

Faulds said other health systems could also implement CGM for use in the hospital. She advised other clinics to take advantage of their strengths and build guidance using the staff, technology and workflows that are already in place.

“This took a lot of creativity on our part at Ohio State, and it constantly felt like we were putting a square peg in a round hole,” Faulds said “It will take creativity at every institution to try to create these systems to use CGM in the inpatient setting.”

Faulds also advised other healthcare institutions to let nurses and other frontline staff lead the drive for implementation, collaborate with other hospitals that are already using CGM and adapt existing tools and processes.