Effective inpatient insulin management is an important safety issue for our patients. Barriers to appropriate insulin use include incorrect timing of prandial insulin administration, failure to administer basal insulin to persons with type 1 DM, and insulin dosage overtreatment resulting in severe hypoglycemia. We studied the use of Abbott professional (blinded) Libre sensor in patients either on basal bolus insulin therapy (n=20) or on IV insulin (n=20) as a potential aide in minimizing insulin errors. The Wake Forest Baptist Health IRB approved the study and all subjects studied signed informed consent. Continuous BG data were aggregated for each subject and compared to point of care blood glucose (BG), iStat, or lab chemistry values. BG results were assessed for comparability (CGM versus Standard BG testing) and in ability to detect hypoglycemia early in those subjects experiencing hypoglycemia.
Analysis of the basal bolus insulin arm revealed that an average difference of standard of care versus CGM glucose reading of 44.80 mg/dL. Differences in basal bolus arm BG comparing 24-hour average CGM glucometric data to standard of care was similar at 43.56 mg/dL. One third of participants in the basal bolus arm had at least one episode of hypoglycemia (BG < 70 mg/dL.) The average BG value in those experiencing a hypoglycemic event in our study group was 59 mg/dL on Standard BG testing. In retrospective review, all episodes of hypoglycemia were detected earlier on CGM technology. In one occurrence, hypoglycemia noted 6 hours sooner on CGM. CGM data consistently shows lower BG values than those using standard methods. Additional data including difference in insulin dosing based on CGM vs. Standard BG testing following completion of the IV insulin arm will be discussed.
J.A. Aloi: Consultant; Self; Medtronic. Research Support; Self; Medtronic. C.E. Price: None.
Wake Forest Baptist Medical Center