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      Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic

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          Abstract

          Continuous glucose monitoring (CGM) has become a widely used tool in the ambulatory setting for monitoring glucose levels, as well as detecting uncontrolled hyperglycemia, hypoglycemia, and glycemic variability. The accuracy of some CGM systems has recently improved to the point of manufacture with factory calibration and Food and Drug Administration clearance for nonadjunctive use to dose insulin. In this commentary, we analyze the answers to six questions about what is needed to bring CGM into the hospital as a reliable, safe, and effective tool. The evidence to date indicates that CGM offers promise as an effective tool for monitoring hospitalized patients. During the current coronavirus disease 2019 crisis, we hope to provide guidance to healthcare professionals, who are seeking to reduce exposure to SARS-Cov-2, as well as preserve invaluable personal protective equipment. In this commentary, we address who, what, where, when, why, and how CGM can be adopted for inpatient use.

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          Most cited references25

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          Sourcing Personal Protective Equipment During the COVID-19 Pandemic

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            Wearable Devices for Ambulatory Cardiac Monitoring: JACC State-of-the-Art Review.

            Ambulatory monitoring devices are enabling a new paradigm of health care by collecting and analyzing long-term data for reliable diagnostics. These devices are becoming increasingly popular for continuous monitoring of cardiac diseases. Recent advancements have enabled solutions that are both affordable and reliable, allowing monitoring of vulnerable populations from the comfort of their homes. They provide early detection of important physiological events, leading to timely alerts for seeking medical attention. In this review, the authors aim to summarize the recent developments in the area of ambulatory and remote monitoring solutions for cardiac diagnostics. The authors cover solutions based on wearable devices, smartphones, and other ambulatory sensors. The authors also present an overview of the limitations of current technologies, their effectiveness, and their adoption in the general population, and discuss some of the recently proposed methods to overcome these challenges. Lastly, we discuss the possibilities opened by this new paradigm, for the future of health care and personalized medicine.
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              Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial

              OBJECTIVE The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. RESEARCH DESIGN AND METHODS We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100–140 mg/dL (n = 151) or to a conservative target of 141–180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events. RESULTS Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124–139) in the intensive and 154 ± 17 mg/dL (IQR 142–164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008). CONCLUSIONS Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings.
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                Author and article information

                Journal
                Journal of Diabetes Science and Technology
                J Diabetes Sci Technol
                SAGE Publications
                1932-2968
                1932-2968
                July 2020
                June 14 2020
                July 2020
                : 14
                : 4
                : 822-832
                Affiliations
                [1 ]Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
                [2 ]Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
                [3 ]Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
                [4 ]Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
                [5 ]Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, USA
                [6 ]Fleischer Institute for Diabetes and Metabolism, NY-Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA
                [7 ]Division of Endocrinology, Atlanta Veterans Affairs Medical Center, GA, USA
                Article
                10.1177/1932296820932903
                32536205
                f77a5dbe-eef4-42b7-b752-19ba0e075dfe
                © 2020

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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