Results from a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults with Type 2 Diabetes: the “TIGHT” Study

Objective: To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes. Research Design and Methods: At 6 academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with a glucose target of 140-180 mg/dL (Standard group) or intensive therapy with glucose target of 90-130 mg/dL guided by CGM (Intensive group). The primary outcome was mean glucose measured with CGM (blinded in Standard group) and the key secondary outcome was CGM glucose <54 mg/dL. Results: Of the 110 participants included in the primary analysis, mean age was 61± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL in the Intensive group (N=60) versus 175 mg/dL in the Standard group (N=50, risk-adjusted difference -7 mg/dL; 95% confidence interval -19 to +5; p = 0.25). Only 7% of the Intensive group achieved the mean glucose target range of 90 to 130 mg/dL. CGM readings below 54 mg/dL were infrequent (0.2% for Intensive and 0.4% for Standard; adjusted treatment group difference = -0.1%, 95% CI -0.6% to 0.3%). One severe hypoglycemia event occurred in the Standard group. Conclusions: The study’s glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non-ICU hospital setting. A glucose target of 90-130 mg/dL may not be realistic in the current environment of insulin management in the hospital.