Pediatric Inpatient Continuous Glucose Monitoring: Development and Implementation of a Hospital Policy for Accuracy-Validated Insulin Dosing.
TL;DR
An inpatient CGM policy from an adult to pediatric hospital setting is translated, supporting high levels of protocol adherence, clinical accuracy, safety, and improved experiences for clinicians.
Abstract
Objective
We assessed the safety, clinical accuracy, glycemic outcomes, user outcomes, and implementation of a pediatric hospital-wide continuous glucose monitor (CGM) policy. RESEARCH
Design
AND
Methods
We used the Model for Improvement to develop a pediatric hospital policy supporting CGM-based insulin dosing with accuracy validation using capillary finger-stick blood glucose (FSBG) and then retrospectively evaluated the program's clinical effectiveness and implementation outcomes with the Simplified Implementation Logic Model to connect contextual determinants, support strategies, and outcomes.
Results
From September 2024 to October 2025, 60 people with diabetes used the CGM policy in 93 hospital encounters, including 46.7% (28/60) people with type 1 diabetes and 38.7% (36/93) encounters with automated insulin delivery use. The most used CGMs were Dexcom G7 (49.5%) and Abbott Libre 3 or 3 Plus (31.2%). Accuracy validation using the %20/20 criteria was successful in 81.5% of attempts, and the mean absolute relative difference was 12.6%, with 1207 paired CGM and reference FSBG values. Nurses responded appropriately after 97.8% (218/223) of failed CGM validation attempts. CGM time in range (70-180 mg/dL) was 54.8%, and time in level 2 hypoglycemia (<54 mg/dL) was 0.8% for the 58 out of 93 encounters with complete CGM data downloads. Nurses preferred using CGM with policy support instead of FSBG for insulin dosing (adjusted P = 0.046). Factors contributing to nursing preference included ease of use, system integration, and the ability to learn the system quickly.
Conclusions
We translated an inpatient CGM policy from an adult to pediatric hospital setting, supporting high levels of protocol adherence, clinical accuracy, safety, and improved experiences for clinicians. Program evaluation informs connections between contextual determinants, support strategies, and outcomes of implementing a hospital CGM program. These data offer a roadmap for implementing pediatric hospital CGM at other centers.