Advancing the Use of CGM Devices in a Non-ICU Setting.
Advancing the Use of CGM Devices in a Non-ICU Setting.
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DOI：
10.1177/1932296818821094
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发表时间：
2019-07-01
影响因子：
5
通讯作者：
Spanakis, Elias K
中科院分区：
文献类型：
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作者：
Wang, Meng;Singh, Lakshmi G;Spanakis, Elias K
使用连续血糖监测 (CGM) 系统可改善血糖控制，这一点已在门诊得到证实。在住院患者中，CGM 的使用主要处于研究阶段，特别是在非 ICU 环境中。尽管没有商用的闭环系统，但最近已在非重症监护环境中对其进行了评估。 CGM 和闭环系统都可以改善血糖控制，缩短住院时间，降低与严重低血糖或高血糖相关的不良事件的风险。住院患者使用 CGM 和闭环系统的局限性包括缺乏 FDA 批准、对该技术缺乏经验以及与供应相关的成本。医院工作人员培训和支持住院患者使用的基础设施开发可能需要大量投资。 CGM 系统的其他限制包括由于药物干扰、传感器滞后或传感器漂移而导致间质葡萄糖测量可能不准确。闭环系统的局限性还包括需要进行常规监测以检测输注部位问题以及进行监测以确保储库中有足够的胰岛素供应，以避免突然停止胰岛素输注导致严重高血糖。医院工作人员必须熟悉在胰岛素泵出现故障时的故障排除和转换为替代胰岛素输送模式。鉴于这些复杂性，闭环系统的实施可能需要内分泌团队的参与，从而限制了广泛采用。本文回顾了非 ICU 环境中 CGM 和闭环系统使用的现状、现有文献、优点和局限性，以及对未来 CGM 设计（特别是住院环境）的建议。
Improvements in glycemic control using continuous glucose monitoring (CGM) systems have been demonstrated in the outpatient setting. Among hospitalized patients the use of CGM is largely investigational, particularly in the non-ICU setting. Although there is no commercially available closed-loop system, it has recently been evaluated in the non-critical care setting. Both CGMs and closed-loop systems may lead to improved glycemic control, decreased length of stay, reduced risk of adverse events related to severe hypoglycemia or hyperglycemia. Limitations of inpatient use of CGM and closed-loop systems include lack of FDA approvals, inexperience with this technology, and costs related to supplies. Significant investment may be necessary for hospital staff training and for development of infrastructure to support inpatient use. Additional limitations for CGM systems includes potential inaccuracy of interstitial glucose measurements due to medication interferences, sensor lag, or sensor drift. Limitations for closed-loop systems also includes need for routine monitoring to detect infusion site issues as well as monitoring to ensure adequate insulin supply in reservoir to avoid abrupt cessation of insulin infusion leading to severe hyperglycemia. Hospital staff must be familiar with trouble-shooting and conversion to alternative mode of insulin delivery in the event of insulin pump malfunction. Given these complexities, implementation of closed-loop systems may require involvement of an endocrinology team, limiting widespread adoption. This article reviews current state of CGM and closed-loop system use in the non-ICU setting, available literature, advantages and limitations, as well as suggestions for future CGM design, specifically for the inpatient setting.