ADA-EASD Statement| September 22 2026
An International Position Statement on Practical Approaches for Inpatient Continuous Glucose Monitoring, Insulin Pumps, and Automated Insulin Delivery Systems in Adults Free
https://diabetesjournals.org/care/article/doi/10.2337/dci26-0091/172552/An-International-Position-Statement-on-Practical
Mikkel T. Olsen Corresponding Author
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There is an urgent and unmet need for a practical clinical guideline addressing the use of continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems in hospital settings. The goal with this position statement is to facilitate effective and safe use of these devices to improve glycemic management, enhance outcomes, and contribute to standardization efforts in initiating or continuing the use of these devices in hospitals for non–critically ill hospitalized adults. The topics covered include selection criteria for management with diabetes technologies, CGM-derived glycemic metrics and goals for adults with diabetes, insulin titration and administration guidelines, perioperative care, CGM alarm settings for hypoglycemia and hyperglycemia, clinical staff training and workflows, integration of device data with the electronic health record, imaging tests considerations, and discharge planning.
This article is being simultaneously published in Diabetes Care and Diabetologia (https://doi.org/10.1007/s00125-026-06838-8) and Diabetes Care (https://doi.org/10.2337/dci26-0091) by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA).
This position statement was reviewed for the EASD by its Committee on Clinical Affairs (CCA) and approved by the EASD Board and for the ADA by its Professional Practice Committee (PPC).
This article contains supplementary material online at Link to An International Position Statement on Practical Approaches for Inpatient Continuous Glucose Monitoring, Insulin Pumps, and Automated Insulin Delivery Systems in Adultshttps://doi.org/10.2337/figshare.32648427.
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https://diabetesjournals.org/care/article/doi/10.2337/dci26-0091/172552/An-International-Position-Statement-on-Practical
Background
Continuous glucose monitoring (CGM) has the potential to improve inpatient glu-
cose management by providing real-time glucose levels every one to five mi-
nutes, creating a detailed and continuous profile of an individual’s glycemic
status (1–4). Unlike traditional point-of-care (POC) glucose testing, typically per-
formed three to five times per day in non–critically ill hospitalized individuals,
CGM minimizes data gaps, which is important in an inpatient setting where high
glycemic variability and rapid shifts in insulin requirements are often seen due to
altered glucose metabolism (5).
Frequent glucose readings and real-time alerts for hypoglycemia and hyperglycemia enable more precise and responsive insulin
titration, which in turn may lead to improved glycemic status and reduce the risk
of complications such as increased morbidity and mortality and prolonged hospi-
tal stays (6–10).
While CGM and insulin pumps—the latter which, if integrated with CGM in associa-
tion with a response algorithm, can work as an automated insulin delivery (AID)
system—have greatly improved diabetes management in the outpatient setting, their
adoption in hospital settings remains limited (11,12).
Several barriers hinder harnessing the full potential of these devices in inpatient diabetes care (13,14).
These barriers include, among others,
• oncerns about accuracy of inpatient CGM,
• conditions under which use of CGMs, insulin pumps, and AID systems is feasible in a hospital settin
• limited integration of data into electronic health records (EHR),
• inadequate clinical staff training on the management of these devices,
• cost and regulatory concerns, and
• the absence of standardized guidelines for
CGM-guided insulin adjustments in non-
AID users (2,13,15–19)
CONCLUSION
This position statement addresses the un-
met need for clinical guidelines on use of
CGM, non-AID insulin pumps, and AID in
non–critically ill hospitalized adults. The
primary goal of this statement is to pro-
mote effective, safe, and consistent use of
these technologies to improve inpatient
glycemic management, enhance clinical
outcomes, and support the standardiza-
tion of the adoption of these technologies
in hospital settings. Importantly, as these
clinical recommendations are based on re-
view of literature on adults, they cannot
be directly extrapolated to the care of
hospitalized pediatric populations.
_____________________
Key Details of the Position Statement
Target Audience:
Non-critically ill hospitalized adults with diabetes. [1]
Core Goal: To provide practical guidance, safety frameworks, and standardization for continuing or initiating continuous glucose monitoring (CGM), non-AID insulin pumps, and automated insulin delivery (AID) systems in hospital settings. [1]
Glycemic Target: Recommends an overall Time in Range (TIR) of 3.9–10.0 mmol/L (70–180 mg/dL). [1]
Key Topics Covered:Device selection criteria for hospitalized patients
CGM-derived metrics and inpatient goals
Insulin titration and administration guidelines
Perioperative care (switching to IV insulin for long/complex surgeries vs. continuing devices for short procedures)
CGM alarm settings for hypo- and hyperglycemia
Clinical staff training and operational workflows
Electronic health record (EHR) data integration and manual documentation
Considerations for imaging tests (such as CT scans) and medication interferences (e.g., high-dose acetaminophen, ascorbic acid, hydroxyurea)
Structured discharge planning [1, 2]
______________________
From the artcile
Future perspectives
It is essential to evaluate the implementation of CGM, non-
AID insulin pump and AID systems in real-world inpatient
diabetes care, outside of strictly controlled research environ-
ments.
Further research is needed to explore and evaluate
use of trend arrows from CGMs in inpatient settings to guide
clinical decisions, as CGM trend arrows may help with pre-
vention of impending hypoglycaemia and hyperglycaemia.
In 2020, the FDA issued a non-objection to use of CGM in
the hospital setting. However, formal regulatory approval for
its use during hospitalisation is still pending from the FDA
in the USA, from the European Commission, responsible
for Conformité Européenne (CE) marking in accordance
with the Medical Device Regulation (MDR 2017/745) in
the European Union and for other regions.
Gathering sufficient data on whether different CGM sys-
tems are accurate enough for standalone use, or whether
adjunctive use of POC glucose tests is necessary, remains
a priority. Additionally, there is limited evidence on the
effects of continuing use of an individual’s own CGM during hospitalisation.
There is a significant gap in data regarding
the effectiveness and safety of non-AID and AID systems
in the inpatient setting.
Moreover, cost–benefit analyses of
diabetes technology use in hospitals are still limited, along
with data on individual and healthcare professional satisfac-
tion with these technologies in the inpatient setting.
Future research should examine whether these technolo-
gies perform differently across distinct groups—including
people with type 1 diabetes, those with type 2 diabetes and
individuals who are either technology naive or already using
diabetes devices.
The optimal CGM-based glycaemic goals
and metrics for preventing in-hospital complications in the
inpatient setting have yet to be fully explored.
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