Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients with Diabetes: A Randomized Clinical Trial
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.