Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2019; 10(9): 473-480
Published online Sep 15, 2019. doi: 10.4239/wjd.v10.i9.473
Future technology-enabled care for diabetes and hyperglycemia in the hospital setting
Alex Renato Montero, Jeffrey S Dubin, Paul Sack, Michelle F Magee
Alex Renato Montero, Paul Sack, Michelle F Magee, MedStar Diabetes Institute, Washington, DC 20010, United States
Alex Renato Montero, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Jeffrey S Dubin, MedStar Washington Hospital Center, Washington, DC 20010, United States
Paul Sack, MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
Michelle F Magee, MedStar Health Research Institute, Washington, DC 20010, United States
Author contributions: Montero AR and Magee MF conceived the study, reviewed the literature and drafted the manuscript; Dubin JS and Sack P reviewed the literature and revised the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: Montero AR, Dubin JS and Sack P have no financial conflicts of interest to declare relevant to any of the content of this editorial. Magee M received funding on behalf of MedStar Health Research Institute during the study period from Eli Lilly for the REWIND Study, From Sanofi for the AMPLITUDE Study, from the Patient-Centered Outcomes Research Institute (NCT-02093234), from the National Institutes of Health (NIH DK-109503) and from Mytonomy. She served as a speaker for the American Diabetes Association and for PRIMED® and on an Advisory Focus Group for Merck.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alex Renato Montero, MD, Assistant Professor, MedStar Diabetes Institute, 100 Irving Street NW (Suite 4114), Washington, DC 20010, United States. arm243@georgetown.edu
Telephone: +1-202-8772383 Fax: +1-202-8776775
Received: June 28, 2019
Peer-review started: June 29, 2019
First decision: August 2, 2019
Revised: August 13, 2019
Accepted: August 27, 2019
Article in press: August 27, 2019
Published online: September 15, 2019

Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging. Inpatient technology-enabled support systems are being designed, adapted and evaluated to meet this challenge. Insulin pump use, increasingly common in outpatients, has been shown to be safe among select inpatients. Dedicated pump protocols and provider training are needed to optimize pump use in the hospital. Continuous glucose monitoring (CGM) has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit (ICU) settings but data on cost effectiveness is lacking. CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns. Compared to unstructured insulin prescription, a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems. Relative efficacy and cost among these systems remains unanswered. An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital. These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.

Keywords: Diabetes, Inpatients, Continuous subcutaneous insulin infusion, Continuous glucose monitoring, Clinical decision support, Patient education, Self-management

Core tip: Achieving optimal glycemic control in inpatients with diabetes and hyperglycemia remains a challenge for hospital providers. An array of technology-supported systems are evolving to assist providers and patients in meeting this challenge. Next generation, robust clinical decision support systems embedded in the electronic medical record are well positioned to replace structured order sets in the near term. If demonstrated to be cost effective, fully automated electronic glycemic management systems may become commonplace, in particular in intensive care unit settings. Novel media platforms hold tremendous potential for expanding access to crucial, effective self-management education for all patients with diabetes in hospital settings.