Implementation strategies for inpatient continuous glucose monitoring-based diabetes management: a systematic review

INTRODUCTION: Continuous glucose monitoring (CGM) provides real-time glucose data that has revolutionized outpatient diabetes care; however, its impact on inpatient care remains limited, likely due to the lack of standardized CGM-based insulin titration protocols, implementation strategies, and proper familiarity with the technology, among others.

METHODS: A systematic literature search was conducted on October 15, 2024, using PubMed and Embase, without a restriction on publication date. The search focused on CGM-based insulin titration protocols and related implementation strategies in non-intensive care unit (non-ICU) settings. This systematic review was registered with PROSPERO (RD42024596819).

RESULTS: A total of 7625 references were screened. Nine protocols for inpatient CGM-based insulin titration and related implementation strategies were identified. Six protocols recommended a weight-based basal-bolus insulin regimen. Insulin titration on basal and bolus insulin was mostly done daily based on either clinical discretion or clearly defined insulin titration protocols. All protocols employed a hybrid approach, utilizing both CGM and finger prick glucose testing to guide glucose management. Diabetes-trained staff oversaw CGM-based insulin titration and glucose management in 5 protocols. CGM alarm settings varied widely, with hyperglycemic alarm thresholds between >13.9 and >22.2 mmol/L and hypoglycemia alarm thresholds between <3.9 and <5.0 mmol/L.

CONCLUSION: We observed considerable variation in the detail and clarity provided by the reviewed protocols. This highlights the need for standardized operational protocols for CGM-based insulin titration and related implementation strategies to implement CGM effectively in non-ICU settings.