dromlakhani Continue vs Discontinue Personal CGM in Inpatient Setting
STEP 1 — Gather Information
Confirm the patient is already using personal CGM, assess high‑risk hypoglycemia criteria (history of severe hypoglycemia, impaired awareness, renal/hepatic dysfunction, etc.), verify CGM device is functional, check for contraindications (extensive skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, interfering medications such as acetaminophen >4 g/day, dopamine, heparin, vitamin C, hydroxyurea), and ensure patient willingness and ability to follow hospital CGM protocols.
STEP 2 — Rule In / Rule Out
If any contraindication to CGM accuracy or patient adherence is present, decide to discontinue personal CGM; otherwise, decide to continue personal CGM in the inpatient setting.
STEP 3 — Classify or Stratify
If the patient uses an algorithm‑driven insulin pump (ADIP) at home, continue CGM with ADIP; if the patient uses CGM alone, continue CGM without ADIP.
STEP 4 — Decide
Continue personal CGM (with ADIP if applicable) and implement a hybrid approach: validate CGM values with periodic point‑of‑care blood glucose (POC‑BG) before insulin adjustments, ensure SMBG availability for confirmation, and integrate CGM data with the EHR when feasible.
Clinical Guardrails / Mimics / Pitfalls
Do not rely on CGM values alone to guide insulin dosing; always confirm with POC‑BG. Avoid CGM use in patients with skin infection, poor perfusion, or on vasoactive drugs. Be aware of medications that cause false CGM readings. Do not discontinue CGM solely due to hospital policy if the patient is eligible and willing to continue.
Concrete Clinical Example
A 68‑year‑old with type 1 diabetes, using personal CGM and ADIP at home, is admitted for pneumonia. She has a history of severe hypoglycemia and impaired awareness. No contraindications are present. The team continues her CGM+ADIP, checks POC‑BG before any insulin changes, and she reports increased safety during hospitalization.
Source: Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac596