Reducing Inpatient Hypoglycemia in the General Wards Using Real-time Continuous Glucose Monitoring: The Glucose Telemetry System, a Randomized Clinical Trial.
Lakshmi G Singh, Medha Satyarengga, Isabel Marcano, William H Scott, Lillian F Pinault, Zhaoyong Feng, John D Sorkin, Guillermo E Umpierrez, Elias K Spanakis
Author Information
Lakshmi G Singh: Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD.
Medha Satyarengga: Center for Diabetes and Endocrinology, University of Maryland Shore Regional Health, Easton, MD.
Isabel Marcano: Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD.
William H Scott: Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD.
Lillian F Pinault: Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD.
Zhaoyong Feng: Pharmaceutical Research Computing, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
John D Sorkin: Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Baltimore, MD.
Guillermo E Umpierrez: Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, GA. ORCID
Elias K Spanakis: Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD ispanakis@som.umaryland.edu. ORCID
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 with type 2 diabetes at high risk for Hypoglycemia were recruited. Participants were randomized to RT-CGM/GTS or point-of-care (POC) blood glucose testing. The primary outcome was difference in InpatientHypoglycemia. RESULTS: Seventy-two participants were included in this interim analysis, 36 in the RT-CGM/GTS group and 36 in the POC group. The RT-CGM/GTS group experienced fewer hypoglycemic events (<70 mg/dL) per patient (0.67 [95% CI 0.34-1.30] vs. 1.69 [1.11-2.58], = 0.024), fewer clinically significant hypoglycemic events (<54 mg/dL) per patient (0.08 [0.03-0.26] vs. 0.75 [0.51-1.09], = 0.003), and a lower percentage of time spent below range <70 mg/dL (0.40% [0.18-0.92%] vs. 1.88% [1.26-2.81%], = 0.002) and <54 mg/dL (0.05% [0.01-0.43%] vs. 0.82% [0.47-1.43%], = 0.017) compared with the POC group. No differences in nocturnal Hypoglycemia, time in range 70-180 mg/dL, and time above range >180-250 mg/dL and >250 mg/dL were found between the groups. The RT-CGM/GTS group had no prolonged Hypoglycemia compared with 0.20 episodes <54 mg/dL and 0.40 episodes <70 mg/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.
