Glucose control in surgical patients at risk of hyperglycemia and hypoglycemia is
essential, as these conditions can lead to infections, poor surgical outcomes, prolonged
hospital stays, and death. In 2022, the prevalence of diagnosed diabetes in Denmark was
6.2%. With the global incidence of diabetes on the rise, the number of patients requiring
glucose control during surgical admissions is increasing.
Point-of-care (POC) fingerstick capillary glucose monitoring (FSGM) is standard in many
hospitals; however, FSGM can be painful, disrupt sleep, and increase postoperative stress
for patients. Additionally, it can be time-consuming, requiring up to two hours of
nursing work per patient daily. This makes timely and prescribed glucose monitoring
challenging in busy surgical wards, potentially leading to untreated hyperglycemia and
hypoglycemia. Moreover, FSGM provides only a snapshot of glucose levels, without
indicating whether glucose is stable, rising, or falling.
An alternative to FSGM is continuous glucose monitoring systems (CGMS), which measure
glucose levels via a subcutaneous sensor every few minutes. CGMS is predominantly used in
ambulatory settings and has been shown to improve glucose regulation. Several studies
have confirmed the accuracy of CGMS compared to FSGM in surgical and medical wards,
reporting an overall mean absolute relative difference ranging from 9.4 to 12.9, making
it acceptable for use in surgical wards. Other studies have reported that CGMS in
surgical and medical wards results in superior glycemic control, reduced hypoglycemia,
insulin usage, and in-hospital complications, and detected significant duration of both
hypo- and hyperglycemia despite protocolized perioperative diabetes management compared
to FSGM.
Studies on patients' perspectives of CGMS have been limited to everyday life and
outpatient settings. One review on patients with type 1 and 2 diabetes experienced
improved convenience, control, and freedom by the use of CGMS but were also overwhelmed
by data and frustrated by inaccuracy, and technical issues, which is consistent with
findings from another review of patients with diabetes type 2. Another study reported
that patients with type 2 diabetes found the technology helpful for disease management,
although it could also serve as an unpleasant reminder of disease progression and cause
discomfort.
One case report has described nurses' experiences with CGMS in hospital wards for
patients with type 1 diabetes. The nurses experienced an increased workload due to
difficulties hearing the device receiver, leading to more frequent patient observations.
In summary, CGMS has been reported to be safe and beneficial in ambulatory settings,
while challenges and knowledge gaps remain in hospital wards. To date, no studies have
compared glucose levels from CGMS with those from a laboratory plasma glucose analyzer as
the reference. This study aims to investigate the effect of CGMS compared to FSGM in
patients with hyperglycemia in general surgical wards on glucose levels, complications,
length of hospital stay, and patient satisfaction and experience with glucose management
during hospitalization and up to three months after discharge. Additionally, the study
will investigate the nursing staff's workload and experience in the surgical ward, and
the accuracy of CGMS throughout hospitalization, including during surgical procedures and
medical imaging.
Seven substudies will be conducted:
Substudy 1 - Glucose levels and management for surgical patients in relation to
hospitalization: Compares point-of-care glucose levels and management using point-of-care
FSGM and point-of-care CGMS during hospitalization and FSGM and continuous glucose
monitoring (CGM) up to three months after discharge.
Substudy 2 - Patient satisfaction with glucose monitoring and management in surgical
wards: Compares patient satisfaction with glucose monitoring and management for surgical
patients using point-of-care FSGM and point-of-care CGMS during hospitalization.
Substudy 3 - Nursing staff's glucose monitoring and management workload in the surgical
ward: Compares the nursing staff's workload with point-of-care FSGM to point-of-care CGMS
for surgical patients.
Substudy 4 (qualitative study) - Patient experience of glucose monitoring and management
in relation to hospitalization in surgical wards: Compares the patient experience with
point-of-care FSGM to point-of-care CGMS and glucose management during hospitalization in
the surgical ward and one compares the patient experience of FSGM with CGM one month
after discharge.
Substudy 5 - Continuous glucose level for surgical patients in relation to
hospitalization in the surgical ward: Compares the continuous glucose levels when glucose
monitoring and management are performed by point-of-care FSGM and point-of-care CGMS in
the surgical ward. Further, it compares continuous glucose levels using point-of-care
FSGM and CGM after discharge.
Substudy 6 - Accuracy of CGMS for surgical patients during hospitalization: Investigates
the accuracy of CGMS by comparing CGMS data with FSGM and plasma glucose data.
Substudy 7 (qualitative study) - Nursing staff's experience with fingerstick monitoring
and CGSM for surgical patients: Compares the nursing staff's experience with
point-of-care FSGM to point-of-care CGMS and glucose management for surgical patients.