Use of In-Hospital Continuous Subcutaneous Insulin Infusion: A Consensus Statement

The use of continuous subcutaneous insulin infusion (CSII) therapy is becoming more complex, and as its use increases, it is important that institutional protocols be in place to ensure safety and successful patient management, according to a new consensus statement published in the Journal of Diabetes Science and Technology.

The Diabetes Technology Society convened a panel of US experts to discuss the current and potential role of CSII therapy in the hospital setting and have issued a consensus statement that provides guidelines for healthcare professionals who may be managing patients using this technology.

In the report, the panel identified contraindications to self-management with CSII while in the hospital: an altered state of consciousness or cognitive impairment, metabolic instability, critical illness requiring intensive care, patient preference, inability to use hands or arms because of injury or trauma, inability to demonstrate competency with using CSII, or unwillingness to comply with hospital policies.

The recommendations also included those for a CSII patient agreement form. These specify that patients must allow hospital staff to inspect the pump and review settings including basal rates, carbohydrate ratios, sensitivity factors, active insulin times, and blood glucose targets; agree to change their infusion site every 48 to 72 hours or as needed; provide own pump supplies; record basal rates and bolus doses; and agree to point-of-care glucose testing by hospital staff, using the hospital’s glucometer, and that the pump may be discontinued and exchanged for a different insulin delivery for certain outlines reasons.

“It would be helpful if more institutions could report on their approaches to assessment and management of insulin pumps in the inpatient setting,” wrote the authors.

Disclosure: David C. Klonoff, MD, is a consultant to Ascensia, EOFlow, Intarcia, Lifecare, Novo Nordisk, Onduo, and Voluntis.

Reference

Thompson B, Korytkowski M, Klonoff DC, Cook CB. Consensus statement on use of continuous subcutaneous insulin infusion therapy in the hospital [published online April 21, 2018]. J Diabetes Sci Technol. doi: 10.1177/1932296818769933