Empowering hospitalized patients with diabetes: implementation of a hospital-wide CGM policy with EHR-integrated validation for dosing insulin
Open accessAbstract
OBJECTIVE: 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. 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 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%). 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.
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A recent retrospective study demonstrated the feasibility of implementation of a hospital-wide personal CGM policy that included EHR integration and CGM validation for insulin dosing; the policy resulted in favorable hospitalized individual and nurse satisfaction.
“However, a recent retrospective study demonstrated the feasibility of implementation of a hospital-wide personal CGM policy that included EHR integration and CGM validation for insulin dosing; the policy resulted in favorable hospitalized individual and nurse satisfaction (43).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [43]
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- Authors
- Lee, M. Y., Seav, S. M., Ongwela, L., Lee, J. J., Aubyrn, R., Cao, F. Y., Kalinsky, A., Aparicio Ramos, O., Gu, Y., Kingston, K., Ivanovic, M., Buckingham, B. A., Desai, D., Lal, R. A., Tan, M., Basina, M., & Hughes, M. S.
- Affiliations
- Stanford Medicine (US)
- Stanford Health Care (US)
- 4Department of Inpatient Systems and Services, Stanford Health Care, Stanford, CA
- Corresponding author
- Hughes, Michael S.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2024-08-14
- Volume
- 47
- Issue
- 10
- Pages
- 1838-1845
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC11417271
- OpenAlex
- W4401582435
- Cited by
- 32
- References
- 25
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 3
- FWCI
- 10.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIDDK (1K23DK122017, 1K23DK138267, 5K12DK122550, P30DK116074)
- Juvenile Diabetes Research Foundation
- Stanford Maternal and Child Health Research Institute
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institutes of Health (T32DK007217)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- continuous glucose monitoring, hospitalized patients, diabetes management, insulin dose, electronic health record integration, hospital policy implementation, type 1 diabetes, artificial pancreas, Dexcom G6, FreeStyle Libre 2
- MeSH terms
- Adult, Aged, Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 1, Female, Hospitals, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Blood Glucose Self-Monitoring, Electronic Health Records
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