Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients with Diabetes: A Randomized Clinical Trial
Year: 2022
Type: other
Abstract: Background: The efficacy and safety of continuous glucose monitoring (CGM) in adjusting inpatient insulin therapy has not been evaluated. Methods: This randomized trial included 185 general medicine and surgery patients with type 1 and type 2 diabetes treated with a basal bolus insulin regimen. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with insulin dose adjusted based on POC results; while in the CGM group, insulin adjustment was based on daily CGM profile. Primary endpoints were differences in time in range (TIR, 70-180 mg/dL) and hypoglycemia (<70 mg/dL and <54 mg/dL). Results: There were no significant differences in TIR (54.51%±27.72 vs 48.64%±24.25, p=0.14), mean daily glucose (183.2±40 mg/dL vs 186.8±39 mg/dL, p=0.36), percent of patients with CGM values <70 mg/dL (36% vs 39%, p=0.68) or <54mg/dL (14% vs 24%, p=0.12) between CGM-guided and POC group. Among patients with ³ 1 hypoglycemic event, compared to POC, the CGM group experienced a significant reduction in hypoglycemia reoccurrence (1.80±1.54 vs 2.94±2.76 events/patient, p=0.03), lower percentage of time below range (TBR) <70 mg/dL (1.89%±3.27 vs 5.47%±8.49, p=0.02), and lower incidence-rate ratio <70 mg/dL (0.53, 95% CI:0.31-0.92) and <54 mg/dL (0.37, 95% CI:0.17-0.83). Conclusion: The inpatient use of real-time Dexcom G6 CGM is safe and effective in guiding insulin therapy resulting in a similar improvement in glycemic control and a significant reduction of recurrent hypoglycemic events compared to POC-guided insulin adjustment.
Authors: Elias K. Spanakis, Agustina Urrutia, Rodolfo Galindo, Priyathama Vellanki, Alexandra L. Migdal, Georgia Davis, Thaer Idrees, Francisco J. Pasquel, Walkiria Zamudio Coronado, Bonnie Albury, Emmenlin Moreno, Lakshmi G. Singh, Isabel Marcano, Sergio Lizama, Chikara Gothong, Kashif Munir, Catalina Chesney, Rebecca Maguire, William H. Scott, M. Citlalli Perez-Guzman, Saumeth Cardona, Limin Peng, Guillermo E. Umpierrez
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4292367706