Until now a patient arriving on a ward with an automated insulin delivery system met a hospital with no written position on whether it should stay on. Most units improvised, and the common default - remove the device, revert to sliding scale - was the least evidence-based option available.
This international position statement addresses non-critically ill hospitalised adults and sets out selection criteria for who may continue on their own technology, the CGM-derived metrics and targets to manage to, insulin titration and administration, perioperative care, alarm thresholds for hypoglycaemia and hyperglycaemia, staff training and workflow, how device data should reach the electronic record, what to do around imaging, and discharge planning.
It is a position statement built on expert consensus rather than a trial, so it standardises practice rather than proving a benefit. That is still the useful thing here: the questions it answers are the ones asked at 2 am by a ward nurse who has never seen a hybrid closed-loop system, and having an agreed answer written down beforehand is most of the problem solved. Indian units running pumps in smaller numbers can lift the workflow and alarm sections directly.
- Agree in advance, in writing, which inpatients may continue their own pump or CGM.
- Set explicit alarm thresholds for the ward rather than leaving the patient's home settings in place.
- Confirm the imaging policy - devices have manufacturer restrictions around CT, MRI and radiotherapy.
- Name who on each shift is competent to troubleshoot the device, and what happens when nobody is.
- Plan the discharge handover of device data at admission, not on the discharge round.
Why it matters
The default of removing a patient's closed-loop system on admission has never had evidence behind it, and now there is an agreed alternative to point to.
Don't overread it
Expert consensus, not trial evidence - it standardises practice rather than demonstrating better outcomes.
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