Inpatient Provider Experience with Diabetes Technology Use on General Medicine Wards: Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitors (CGM)

In the advent of increased use of technology in diabetes care, the management of CSII and CGM devices in the inpatient setting has not been well described. We conducted a non-incentivized survey among inpatient licensed independent practitioners (LIP) at 4 large US hospital systems to assess their knowledge, comfort, and behaviors related to the use of CSII and CGM in the inpatient setting. Of 128 respondents, 83% were day and night hospitalists, 10% advanced practice providers, and 7% primary care physicians. Most LIPs worked in academic centers (68%), 18% at community teaching hospitals, with 93% having diabetes consult service, and 55% having dedicated teams to assist with use of CSII and CGM. Most respondents (96%) rated inpatient hyperglycemia treatment as important, and 93% of LIPs agreed that CSII should be continued in the inpatient setting in the absence of contraindication. However, only half (49%) reported reviewing CSII settings on admission, and of those, only 50% were confident with interpreting those parameters to guide therapy. Almost two-thirds (64% ) of providers reported knowledge of a CSII policy at their institution. The most common barriers to continuing CSII included lack of LIP knowledge and perceived lack of nursing knowledge regarding CSII. LIPs were less familiar with the use of CGM, with 72% being unaware or not at all familiar with their institution’s policy. Of 64 respondents who cared for a patient with CGM in the preceding 6 months, 56% reported not reviewing CGM data to guide therapy. Most inpatient providers value glycemic control and use of DM technology; however, many reported limited in-depth knowledge of CSII and CGM devices for optimal use to guide clinical care in the inpatient setting. Educational programs and collaboration between LIPs and endocrinologists are needed to safely optimize the use of CSII and CGM in the hospital setting. Disclosure N. Z. Madhun: None. R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. J. Donato: None. P. Hwang: None. H. F. Shabbir: None. M. Fowler: Other Relationship; Self; AstraZeneca. E. Molitch-hou: None. G. E. Umpierrez: Research Support; Self; AstraZeneca, Dexcom, Inc., Novo Nordisk. M. Lansang: Consultant; Self; Sanofi, Research Support; Self; Dexcom, Inc.