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In-hospital DIAbetes management by a diabetes TEam and insulin titration algorithms based on Continuous glucose monitoring or point-of-care glucose testing in patients with type 2 diabetes (DIATEC) a randomised controlled trial

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posted on 2025-01-31, 15:05 authored by Mikkel T. Olsen, Carina K. Klarskov, Signe H. Jensen, Louise M. Rasmussen, Birgitte Lindegaard, Jonas A. Andersen, Hans Gottlieb, Suzanne Lunding, Ulrik Pedersen-Bjergaard, Katrine B. Hansen, Peter L. Kristensen

Objective: The DIATEC trial investigates the glycaemic and clinical effects of inpatient continuous glucose monitoring (CGM)-guided insulin titration by diabetes teams. Research design and methods: This two-centre trial randomised 166 non-intensive care unit patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing or CGM. The primary outcome was the difference in time in range (TIR) (3.9–10.0 mmol/l) between the two arms. Outcomes were assessed during hospitalisation. Results: The CGM-arm achieved a higher TIR (median, IQR) of 77.6% (24.4) vs 62.7% (31.5) in the POC-arm (p <.001). Time above range (TAR) >10.0 mmol/l was lower in the CGM-arm of (median, IQR) 21.1% (24.8) vs 36.5% (30.3) in the POC-arm (p=.001). Time below range (TBR) <3.9 mmol/l was reduced by CGM, with a relative difference to POC of 0.57 (95% CI 0.34–0.97) (p =.042). Prolonged hypoglycaemic events decreased (IRR 0.13, 95% CI 0.04–0.46) (p =.001), and the coefficient of variation (mean, SD) was lower in the CGM-arm of 25.4% (6.3) vs 28.0% (8.2) in the POC-arm (p =.024). Total insulin doses (mean, SD) were reduced in the CGM-arm with 24.1 IU/day (13.9) vs 29.3 IU/day (13.9) in the POC-arm (p =.049). A composite of complications was lower in the CGM-arm (IRR 0.76, 95% CI 0.59–0.98) (p=.032). Conclusions: In-hospital CGM increased TIR by 15%-points, mainly by reducing TAR. CGM also lowered TBR, glycaemic variability, prolonged hypoglycaemic events, insulin usage, and in-hospital complications.

Funding

Novo Nordisk Foundation (grant no. NNF20SA0062872), Vissing Fonden, Jascha Fonden, Copen-hagen University Hospital North Zealand Research Grant, Fru Olga Bryde Nielsen Fonden, PhD‐START‐ puljen North Zealand Hospital, A.P. Møller Fonden til Lægevidenskabens Fremme, A & J C Tvergaards Fond, Læge Inger Goldmanns Fond, Ellen Cramers Fond, and Torben og Alice Fri-modts Fond.

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