Implementation Strategies for Inpatient Continuous Glucose Monitoring-based Diabetes Management: A Systematic Review

Olsen, Mikkel T; Liarakos, Alexandros L; Wilmot, Emma G; Dhatariya, Ketan; Thabit, Hood; Sánchez-García, David; Nørgaard, Kirsten; Pedersen-Bjergaard, Ulrik; Hansen, Katrine B; Vangoitsenhoven, Roman; Mathieu, Chantal; Kristensen, Peter L; Mader, Julia K

Abstract

Introduction
Continuous glucose monitoring (CGM) provides real-time glucose data that has revolutionised outpatient diabetes care; however, its impact on inpatient care remains limited, likely due to the lack of standardised 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 7,625 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, utilising both CGM and finger prick glucose testing to guide glucose management. Diabetes-trained staff oversaw CGM-based insulin titration and glucose management in five protocols. CGM-alarm settings varied widely, with hyperglycaemic alarm thresholds between >13.9 and >22.2 mmol/l, and hypoglycaemia 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 standardised operational protocols for CGM-based insulin titration and related implementation strategies to implement CGM effectively in non-ICU settings.

Citation

Olsen, M. T., Liarakos, A. L., Wilmot, E. G., Dhatariya, K., Thabit, H., Sánchez-García, D., Nørgaard, K., Pedersen-Bjergaard, U., Hansen, K. B., Vangoitsenhoven, R., Mathieu, C., Kristensen, P. L., & Mader, J. K. (2025). Implementation Strategies for Inpatient Continuous Glucose Monitoring-based Diabetes Management: A Systematic Review. Journal of Clinical Endocrinology and Metabolism, 110(7), e2411–e2419. https://doi.org/10.1210/clinem/dgaf074

• Journal Article Type: Article
• Acceptance Date: Feb 4, 2025
• Online Publication Date: Feb 7, 2025
• Publication Date: 2025-07
• Deposit Date: Feb 5, 2025
• Publicly Available Date: Feb 8, 2026
• Journal: Journal of Clinical Endocrinology and Metabolism
• Print ISSN: 0021-972X
• Electronic ISSN: 1945-7197
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 110
• Issue: 7
• Pages: e2411–e2419
• DOI: https://doi.org/10.1210/clinem/dgaf074
• Keywords: Diabetes; in-hospital; inpatient; dose; continuous glucose monitoring; insulin titration
• Public URL: https://nottingham-repository.worktribe.com/output/45037966
• Publisher URL: https://academic.oup.com/jcem/article-abstract/110/7/e2411/8004984