Remote Monitoring is Working in the Fight Against COVID-19

The COVID-19 pandemic has turned our world upside down. It has presented unique challenges in how clinicians, and particularly nurses and nursing assistants on the frontlines, can provide the best quality of care for patients while maximizing their safety and minimizing frontline staff’s exposure to the virus.

As areas across the country are still grappling with continued cases of COVID-19, it’s critically important for hospitals to quickly adopt the most effective technologies and best practices established by hospitals like Rush University Medical Center in Chicago that were hit early in the pandemic.

One of the innovative technologies we are using at Rush that has shown incredible promise in the fight against COVID-19 in ambulatory and hospital settings is continuous glucose monitoring (CGM).

For decades, the traditional method used by hospital staff to monitor patient glucose levels has been fingerstick glucose testing, which requires nurses or nurse assistants to enter a patient’s room as often as once an hour for a manual finger-stick to get a glucose reading. Due to the need to preserve personal protective equipment and reduce the frequency of hospital staff exposure to the coronavirus, the U.S. Food and Drug Administration has made CGM systems temporarily available for remote patient monitoring in the hospital setting.

CGM systems, such as the Dexcom G6, use a small, wearable sensor and transmitter to continuously measure and send glucose levels wirelessly to a compatible receiving device. The systems provide real-time glucose data, reduce the need for fingersticks and are capable of enabling remote monitoring from outside a patient’s room.

For patients with COVID-19, and especially those with diabetes who are four times more likely to die from coronavirus complications, monitoring glucose levels continuously is an essential task for glucose and diabetes management in the hospital setting. Additionally, a recent study from the Journal of Diabetes Science and Technology, Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States, has shown improved glycemic control can result in an increased chance of recovery from the virus.

Early and Promising Results

Rush University Medical Center was one of the first hospitals in the country to use CGM systems for remote glucose monitoring (glucose telemetry) with hospitalized COVID-19 patients. In the face of the worst healthcare crisis in more than a generation, our team knew we needed to implement innovative, new approaches to better care for our patients and protect our staff from the virus. Over the last four months, the results of glucose telemetry have been game-changing for both our patients and our staff in the continued fight against COVID-19.

Our preliminary data suggest that with 34 patients using glucose telemetry, our hospital was able to save nearly 1,400 sets of personal protective equipment and about 43 nursing workdays by reducing the need for nursing staff to enter patient rooms for fingerstick glucose testing. Moreover, real-time, dynamic glucose trends help patients avoid severe insulin-induced hypoglycemia before it happens.

CGM provides more data than fingerstick glucose tests and the potential to improve the safety of hospitalized patients treated with insulin. CGM technology is a new chapter for glycemic control and insulin safety in hospital. CGM use at Rush helped us to improve inpatient glycemia management protocols, food and nutrition protocols and uncovered issues previously missed with episodic fingerstick glucose monitoring.

Making Way for a New Standard of Care

The implementation of new protocols and technology in the hospital setting is challenging at the best of times, let alone during a pandemic, but at RUSH we have established, tested and continue to improve the protocols for remote glucose monitoring technology in our hospital. We have proven the implementation challenges are possible to overcome, and the safety advantages of remote glucose monitoring are hard to dispute. During the heat of the first peak of COVID-19 infection in Chicago, we were able to implement continuous glucose monitoring technology using just-in-time onsite training of the nursing staff

This proves that glucose telemetry is feasible in the hospital setting, while we continue to improve the implementation protocols. Moreover, this is the way of the future not only during the COVID-19 pandemic, but also for patients requiring isolation in other situations, such as clostridium difficile or antimicrobial resistant pathogens.

Change is possible, even in challenging times, and we have a better chance of winning the fight against this invisible enemy if our hospitals and payors facilitate the adoption of innovative technologies and new best practices. The time is now for every hospital, healthcare system and all payors in the United States to adopt CGM as the standard of care for glucose monitoring. In the midst of this continuing pandemic—and long after—the wellbeing of our patients and our frontline clinicians depend on it.

Rasa Kazlauskaite, MD, MSc, FACE, director of diabetes technology program at Rush University Medical Center.