Empowering Hospitalized Patients with Diabetes: Implementation of a Hospital-Wide CGM Policy with EHR-Integrated Validation for Dosing Insulin

Objective: We aimed to assess the feasibility, clinical accuracy, and acceptance of a hospital-wide continuous glucose monitor (CGM) policy with electronic health record (EHR)-integrated validation for insulin dosing.

Research Design and Methods: 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.

Results: From November 2022 to August 2023, 135 patients used the CGM protocol in 185 inpatient encounters. This included 26% non-English speakers, 27% with type 1 diabetes, and 23% with automated insulin delivery systems. Most used CGMs were Dexcom G6 (44%) and Libre 2 (42%). Of 1506 CGM validation attempts, 87.8% met the /20 criteria 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%).

Conclusions: 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.