VA Researcher Explores Continuous Glucose Monitoring Use to Prevent Hypoglycemia in the Hospital

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Devices Can Protect Health Care Providers During COVID-19 Pandemic Hypoglycemia (low blood glucose levels) in hospitalized patients can lead to loss of consciousness, seizures, prolonged length of hospital stay, or even death. A researcher at the VA Maryland Health Care System, conducted the first investigational study of insulin-treated patients with Type 2 diabetes to see if the use of continuous glucose monitoring devices can prevent hypoglycemia in inpatients on medical units. Dr Ilias (Elias) Spanakis, a physician and researcher at the VA Maryland Heath Care System and associate professor at the University of Maryland School of Medicine and the study’s principle investigator, used continuous glucose monitoring devices in the first randomized two-year clinical trial that included 72 patients and found that this intervention reduced the number of hypoglycemic events inpatients suffered.

"Dr. Spanakis’ study demonstrates that glucose levels can be monitored more frequently and efficiently," said Dr. Thomas J. Hornyak, associate chief of staff for Research and Development at the VA Maryland Heath Care System.

Hypoglycemia (low blood glucose levels) in hospitalized patients can lead to loss of consciousness, seizures, prolonged length of hospital stay, or even death. A researcher at the VA Maryland Health Care System, conducted the first investigational study of insulin-treated patients with Type 2 diabetes to see if the use of continuous glucose monitoring devices can prevent hypoglycemia in inpatients on medical units. Dr Ilias (Elias) Spanakis, a physician and researcher at the VA Maryland Heath Care System and associate professor at the University of Maryland School of Medicine and the study’s principle investigator, used continuous glucose monitoring devices in the first randomized two-year clinical trial that included 72 patients and found that this intervention reduced the number of hypoglycemic events inpatients suffered. The Food and Drug Administration has not approved the use of continuous glucose monitoring devices in the hospital setting and this trial offers the first evidence of their efficacy. Study findings will be published in the forthcoming issue of peer-reviewed journal Diabetes Care in an article titled, “Reducing inpatient hypoglycemia in the general wards using real-time DEXCOM CGM - the Glucose Telemetry system: A randomized clinical trial.” The article is available at this link: https://care.diabetesjournals.org/lookup/doi/10.2337/dc20-0840

“Typically, glucose monitoring relies on point-of-care finger sticks which must happen frequently to prevent adverse events in patients with diabetes,” said Dr. Thomas J. Hornyak, associate chief of staff for Research and Development at the VA Maryland Heath Care System. “Dr. Spanakis’ study demonstrates that glucose levels can be monitored more frequently and efficiently. Also, in the face of the COVID-19 pandemic, use of the continuous glucose monitoring systems proved to be prescient, showing a decrease in hypoglycemia while also safeguarding health care providers caring for virus-positive patients with diabetes.”

In addition to Spanakis, an eight-member interdisciplinary team, which included Dr. Lakshmi G. Singh, Dr. Medha Satyarengga, Dr. Isabel Marcano, Dr. William H. Scott, Lillian F. Pinault, Zhaoyong Feng, Dr. John D. Sorkin, and Dr. Guillermo E. Umpierrez, sought to explore ways to reduce hypoglycemia and increase patient safety. The purpose of the trial was to explore if continuous glucose monitoring devices combined with a simplified hypoglycemia prevention protocol could reduce hypoglycemic events in patients predisposed to such. For the study, the patients were divided into two groups, 36 monitored remotely with continuous glucose monitoring devices and 36 monitored via traditional point-of-care finger stick testing; patients in the continuous glucose monitoring group experienced fewer episodes of hypoglycemia, a condition leading to seizures, comas, arrhythmias, increased lengths of hospital stays, and death.

“Studies have indicated that insulin use in hospitalized patients with diabetes predisposes them to hypoglycemia, a condition that is associated with increased morbidity and mortality. Preventing hypoglycemia requires intensive glucose monitoring. Frequent point-of-care finger sticks with a goal to monitor closely glucose levels is not easy as this approach may be painful and surveillance of these patients in a busy hospital environment may increase nursing workload,” Spanakis said.

The continuous glucose monitoring devices check glucose levels every five minutes and transmit the results to a centralized monitoring device (i.e. tablet) at the nurses’ station, where alerts would sound when a patient’s glucose levels started to decrease and approach dangerous levels. Nurses responding to alerts, could then take corrective actions, preventing a hypoglycemic event. Although not tested in COVID-19 subjects, as the COVID-19 pandemic unfolded, an unexpected benefit of using these devices included the monitoring of glucose levels of COVID-19 positive patients remotely while safeguarding health care providers by eliminating entry to patients’ rooms for obtaining point-of-care finger stick glucose testing.

Diabetes Care is the official journal of the American Diabetes Association (ADA) ranking fourth in its impact in the areas of endocrinology and metabolism for the health care practitioner intended to increase knowledge, stimulate research, and promote better management of people with diabetes. Diabetes Care publishes original research on human studies in the following categories: Clinical Care/Education/Nutrition, Psychosocial Research,

Epidemiology/Health Services Research, Emerging Treatments and Technologies, Pathophysiology/Complications, and Cardiovascular and Metabolic Risk. The journal also publishes ADA statements, consensus reports, clinically relevant review articles, letters to the editor, and health/medical news or points of view. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators, and other health professionals.
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MEDIA NOTE: To interview Dr. Ilias (Elias) Spanakis contact Rosalia Scalia at Rosalia.scalia@va.gov, or by calling 410-736-8444.

The VA Maryland Health Care System (VAMHCS) provides a broad spectrum of medical, surgical, rehabilitative, mental health and outpatient care to veterans at three medical centers and five outpatient clinics located throughout the state. More than 52,000 veterans from various generations receive care from VAMHCS annually. Nationally recognized for its state-of-the-art technology and quality patient care, VAMHCS is proud of its reputation as a leader in veterans’ health care, research and education. It costs nothing for veterans to enroll for health care with the VA Maryland Health Care System and it could be one of the more important things a veteran can do. To enroll for VA health care, interested veterans can call 877-222-8387 Monday through Friday from 8 a.m. to 8 p.m., or they can visit http://www.va.gov and clinic on “Apply now for VA health care.”

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Rosalia Scalia
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