Wake Forest Baptist Health in Winston-Salem, N.C., this spring began trying out a new use for wearable continuous glucose monitors: to give care teams more information when adjusting insulin doses for inpatients. It’s an example of a health system repurposing medical wearables.
Continuous glucose monitoring, or CGM, has been a part of outpatient diabetes management and treatment for years. Dr. Joseph Aloi, section chief for endocrinology and metabolism at Wake Forest Baptist Health, said he’s seen outpatient adoption tick up in the past three to five years in particular, as needles have gotten smaller, sensors can be worn longer and the technology has become more affordable.
However, the technology is still considered investigational in the inpatient setting, where inpatient glycemic management teams tend to rely on traditional finger-stick tests to determine whether they need to adjust a patient’s insulin.
That’s changed, at least temporarily, at Wake Forest Baptist Health during the pandemic.
Inpatients with diabetes are offered the option to use a CGM sensor from Abbott Laboratories; it’s about the size of a quarter and worn on the upper arm for 14 days. Abbott donated the wearable sensors in April, after the Food and Drug Administration approved the system for use in the hospital setting during the COVID-19 emergency.
Traditionally, nurses check a patient’s blood sugar with finger-stick tests before each meal and at bedtime. “So that’s four finger-stick blood sugars a day,” Aloi said. “With the sensor, we’re getting more than 100 data points a day,” something he thinks will provide a more comprehensive way to tailor patients’ insulin needs.
During the pandemic, continuous glucose monitoring has helped reduce infection risks, since nurses don’t need to enter a patient’s room several times a day for bedside finger-stick tests, Aloi said.
A study published by TouchEndocrinology concluded that cost differences vary by volume. If a Type 1 diabetes patient is using eight finger sticks per day, the annual cost is $4,380; six finger sticks/day, the annual cost is $3,285; for three finger sticks/day, the annual cost is $1,643. CGM costs $1,712 annually, lower than six to eight tests per day, but comparable to three daily tests.
“This is all (an) emerging change in practice,” Aloi said. But “my personal bias is that this is going to replace finger-stick testing in the hospital.”
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