november 2020 • Diabetes Care

Reducing inpatient hypoglycemia in the general wards using real-time continuous glucose monitoring: The glucose telemetry system, a randomized clinical trial.

Singh LG, Satyarengga M, Marcano I, et al.

DOI: doi:10.2337/dc20-0840

Content curated by:Paulo Faria de Sousa

Key message

Em doentes diabéticos insulinotratados e internados, o risco de hipoglicemia foi diminuído pela utilização de monitorização glicémica contínua em tempo real.

Analysis

Method

Ensaio clínico aleatorizado não ocultado – análise interina pré-planeada. Estudo foi interrompido pela pandemia COVID19 e autores publicaram dados disponíveis. -População – Adultos com diabetes tipo II insulinotratada em elevado risco de hipoglicemia (>65 anos, IMC < 27, dose total diária de insulina > 0.6 u/kg, antecedentes de insuf. renal, insuf. hepática, neoplasia activa, AVC, infecção sistémica ou hipoglicemia em internamento recente) -Intervenção – Monitorização de glicemia continua em tempo real (RT-CGM) + tratamento hipoglicemias -Comparadores – glicemia capilar + tratamento hipoglicemias -Outcomes – diferenças no número, duração e gravidade de hipoglicemias medidas com RT-CGM.

Results

Incluídos 72 doentes – 36 em cada grupo. - Nº eventos hipoglicemicos por doente (< 70 mg/dL) - RT-CGM/GTS = 0.67 | Controlo 1.69 – Diferença de Risco Absoluto = 1.02 - Nº eventos hipoglicemicos por doente (< 54 mg/dL) - RT-CGM/GTS = 0.08 | Controlo 0.75 - Não foram detectadas diferenças significativas nas hipoglicemias nocturnas, no tempo com valores entre 70-180 e nas hiperglicemias.

Abstract

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 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. 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], P = 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], P = 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%], P = 0.002) and <54 mg/dL (0.05% [0.01–0.43%] vs. 0.82% [0.47–1.43%], P = 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.