Published online Sep 15, 2019. doi: 10.4239/wjd.v10.i9.473
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.
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.