The Ohio State University Wexner Medical Center is one of a few hospitals in the nation to have sustained large-scale clinical use of continuous glucose monitoring (CGM) in critical care settings.
Although people have safely and effectively used CGM to manage their diabetes in the outpatient setting for several decades, the technology isn’t yet approved for hospital use. In the ICU in particular, stand-alone use of CGM is not feasible due to concerns about its accuracy.
However, one solution is a hybrid protocol that combines the use of CGM with periodic fingerstick glucose measures. Ohio State first tested the use of CGM in this way during the COVID-19 pandemic under FDA emergency allowance.
“Effective glucose testing has always been a source of consternation in the hospital setting,” says Eileen Faulds, PhD, APRN-CNP, an assistant professor in The Ohio State University College of Nursing and an inpatient diabetes provider. “The medical community has relied on the same finger prick meters for decades, which provide an intermittent, narrow look at patient’s glucose. It’s why over 30% of hypoglycemia is often missed, and the lack of data threatens outcomes, especially in the ICU.
“People with diabetes are about 33% more likely to be hospitalized. They have longer stays, worse outcomes and are more likely to be treated in the intensive care unit,” Dr. Faulds says. “The pandemic only amplified the need for a solution.”
Multiple studies have confirmed that Ohio State’s use of CGM not only has the potential to improve patient outcomes, but also to reduce nursing workload.
“We’ve looked at how nurses use the CGM systems and the glucose data they produce. We’ve used this information to develop standards and policies for successful implementation of this technology,” she says. “Among the advantages are an ability to measure glucose levels at any time without disturbing the patient. Alarms inform nursing when the patient’s glucose is too high, too low or predicted to be low in the future based on glucose trends. In the future, we’ll be able to combine CGM data with machine learning to help care teams make smarter choices.”
Dr. Faulds and her multidisciplinary research team – including Ohio State endocrinologist Kathleen Dungan, MD; critical care specialists Matthew Exline, MD, and Lauren Jones, APRN-CNS; biostatistician Abigail Shoben, PhD; implementation science researcher Molly McNett, PhD, RN, CNRN; and health care economist Chyongchiou Lin, PhD – expect their latest study, Expanding use of continuous glucose monitoring beyond COVID in critical care: Impact on nurse work patterns and patient outcomes, to be published in the second quarter of 2025. This research, which began in August 2022 and concluded in September 2024, evaluated the feasibility of implementing CGM plus point-of-care (POC) protocol in critical care settings. “Our intent has been to facilitate rapid adoption of CGM in routine care for hospitalized patients,” Dr. Faulds says.
Research objectives were to:
- Assess the clinical utility, fidelity and adoption of Dexcom G6 CGM in dosing decisions among medical ICU (MICU) patients.
- Evaluate the impact of CGM on nursing workload and care delivery factors through time-in-motion analysis, surveys and focus groups.
- Compare glycemic control in patients using CGM in the MICU to historical controls using POC glucose monitoring.
- Conduct an exploratory economic evaluation and assess hospitalization outcomes including length of stay, costs and discharge levels.
“We were able to confirm the efficacy of GCM for improving insulin-dosing decisions, reducing nursing workload and increasing glucose monitoring frequency. This latest research only reinforces what we found in previous studies, and, as we anticipated, it was a win-win – for the nursing team and for patients who had better glycemic control,” Dr. Faulds says.
Reinforcing results
The previous Ohio State publications, in the order they were completed, include:
- Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19
- Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study
- Nursing Perspectives on the Use of Continuous Glucose Monitoring in the Intensive Care Unit
“These earlier studies helped us quantify CGM effectiveness and understand the initial barriers and facilitators to implementation,” Dr. Faulds says. “They fueled the improvements we’ve made in device setup, workflow efficiency, training, documentation and daily use of CGM in the ICU, particularly for patients requiring intravenous insulin.” The research-to-date also confirms that newer generation devices provide better accuracy and fewer interferences and that ICU nurses overwhelmingly accept and prefer the use of CGM over POC glucose testing alone.
“The positive feedback from Ohio State nurses has been especially crucial in our successful adoption of this new standard of care, and now we’re motivated to facilitate CGM use in more ICU settings nationwide,” she says.
If you’d like more information or have questions about adopting the same standard of care in your own inpatient settings, you can contact Dr. Faulds at Eileen.Faulds@osumc.edu.