Continuous Glucose Monitoring–Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial

• Type of Material: Article
• Authors: Elias K Spanakis, University of Maryland, Baltimore, Maryland; Maria Urrutia, Emory University; Rodolfo Galindo, Emory University; Priyathama Vellanki, Emory University; Alexandra Migdal, Emory University; Georgia Davis, Emory University; Maya Fayfman, Emory University; Thaer Idrees, Emory University; Francisco Javier Pasquel, Emory University; Walkaria Zamudio Coronado, Emory University; Bonnie Albury, Emory University; Emmenlin Moreno, Emory University; Lakshmi G Singh, Baltimore VA Medical Center; Isabel Marcano, University of Maryland; Sergio Lizama, University of Maryland; Chikara Gothong, University of Maryland; Saumeth Cardona, Emory University; Limin Peng, Emory University; Guillermo E. Umpierrez, Emory University
• Language: English
• Date: 2022-08-19
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2022, American Diabetes Association
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.2337%2Fdc22-0716
• Title of Journal or Parent Work: Diabetes Care
• Volume: 45
• Issue: 10
• Start Page: 2369
• End Page: 2375
• Grant/Funding Information: This investigator-initiated study was funded by Dexcom. E.K.S. is supported in part by a Veterans Affairs Merit award from the U.S. Department of Veterans Affairs Clinical Science Research and Development Service (1I01CX001825). R.J.G. is partially supported by research grants from National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grants P30DK111024 and 1K23DK123384-03. P.V. is supported in part by NIDDK grant 1K23DK113241. G.D. is supported by the NIDDK under award number 1K23DK122199-01A1. F.J.P. is supported in part by NIDDK grants K23GM128221 and P30DK111024-06. G.E.U. is partly supported by research grants from the NIH/National Center for Advancing Translational Sciences (Clinical and Translational Science Award program grant UL 3UL1TR002378-05S2) and the NIH/National Center for Research Resources (NIH/NIDDK 2P30DK111024-06).
• Keywords: continuous glucose monitoring; insulin administration; hospitalized patients; clinical trials; diabetes
• Research Categories: Health Sciences, Pharmacy; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVE: The efficacy and safety of continuous glucose monitoring (CGM) in adjusting inpatient insulin therapy have not been evaluated. RESEARCH DESIGN AND 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 end points 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 vs. 186.8 ± 39 mg/dL; P = 0.36), or percent of patients with CGM values <70 mg/dL (36% vs. 39%; P = 0.68) or <54 mg/dL (14 vs. 24%; P = 0.12) between the CGM-guided and POC groups. Among patients with one or more hypoglycemic events, compared with 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 <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]). CONCLUSIONS: 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 with POC-guided insulin adjustment.