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Reducing inpatient hypoglycemia in the general wards using real-time CGM- the Glucose Telemetry system: A randomized clinical trial

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posted on 06.08.2020 by Lakshmi G. Singh, Medha Satyarengga, Isabel Marcano, William H. Scott, Lillian F. Pinault, Zhaoyong Feng, John D. Sorkin, Guillermo E. Umpierrez, Elias K. Spanakis
OBJECTIVE: Use of real-time continuous glucose monitoring (RT-CGM) systems in the inpatient setting is considered investigational. The objective of this study was to evaluate whether RT-CGM, using the glucose telemetry system (GTS), can prevent hypoglycemia in the general wards.

RESEARCH DESIGN AND METHODS: In a randomized clinical trial, insulin-treated patients at high risk for hypoglycemia with type 2 diabetes were recruited. Participants were randomized to RT-CGM/GTS or point of care (POC) blood glucose testing. The primary outcome was difference in inpatient hypoglycemia.

RESULTS: Seventy-two participants were included in this interim analysis, 36 in the RT-CGM/GTS group and 36 in the POC group. RT-CGM/GTS group experienced fewer hypoglycemic events (<70 mg/dL) per patient (0.67 events per patient, 95% CI 0.34-1.30 versus 1.69 events per patient, 95% CI 1.11-2.58, p=0.024) and fewer clinically significant hypoglycemic events (<54 mg/dL) per patient (0.08 events per patient, 95% CI 0.03-0.26 versus 0.75, 95% CI 0.51-1.09, p=0.003). RT-CGM/GTS had lower percentage of time spent below range <70 mg/dl (0.40%, 95% CI 0.18%-0.92% versus 1.88%, 95% CI 1.26%-2.81%, p=0.002) and <54 mg/dL (0.05%, 95% CI 0.01%-0.43% versus 0.82%, 95% CI 0.47%-1.43%, p=0.017) compared to POC group. No differences in nocturnal hypoglycemia, time in range 70-180 mg/dL, time above range >180-250 mg/dL and >250 mg/dL were found between the groups. RT-CGM/GTS group had no prolonged hypoglycemia compared to 0.20 episodes <54mg/dL and 0.40 episodes <70mg/dL per patient in the POC group.

CONCLUSIONS: RT-CGM/GTS can decrease hypoglycemia among hospitalized high risk insulin treated patients with type 2 diabetes.

Funding

This work was supported in part by the VA MERIT award (#1I01CX001825) from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service, the Baltimore VA Medical Center GRECC (Geriatric Research, Education, and Clinical Center), NIA P30 AG028747 (JDS) and NIDDK DK072488 (JDS).

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