An international position statement in Diabetes Care (22 September) sets out practical rules for continuous glucose monitoring (CGM), insulin pumps and AID in non-critically ill adults in hospital. It covers who can safely stay on their own device, CGM targets and alarm thresholds, insulin titration, the perioperative period, imaging, staff training, record integration and discharge.
Many wards still remove a pump on admission by default, which forces a person who runs their own diabetes well onto unfamiliar basal-bolus regimens. The statement's direction is the opposite: continue the device where the patient is alert and able, with a clear plan for when that changes.
It is consensus guidance, not trial evidence, and local protocols still govern. It is a useful template for a hospital that has none — particularly for the questions that cause most trouble: MRI and CT, surgery, and who adjusts settings overnight.
- Ask on admission whether the patient uses CGM, a pump or AID, and record the device
- Agree in writing who adjusts settings and when ward staff should switch to subcutaneous insulin
- Check device guidance before MRI, CT and diathermy; most sensors need removing or shielding
- Confirm capillary glucose for treatment decisions where local policy requires it
- Plan discharge supplies and settings before the day of discharge
Why it matters
Default removal of diabetes technology in hospital is the habit this guidance most directly challenges.
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