Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial.

Autor:	Spanakis EK; University of Maryland Medical Center, Baltimore, MD.; Baltimore VA Medical Center, Baltimore, MD., Urrutia A; Emory University School of Medicine, Atlanta, GA., Galindo RJ; Emory University School of Medicine, Atlanta, GA., Vellanki P; Emory University School of Medicine, Atlanta, GA., Migdal AL; Emory University School of Medicine, Atlanta, GA., Davis G; Emory University School of Medicine, Atlanta, GA., Fayfman M; Emory University School of Medicine, Atlanta, GA., Idrees T; Emory University School of Medicine, Atlanta, GA., Pasquel FJ; Emory University School of Medicine, Atlanta, GA., Coronado WZ; Emory University School of Medicine, Atlanta, GA., Albury B; Emory University School of Medicine, Atlanta, GA., Moreno E; Emory University School of Medicine, Atlanta, GA., Singh LG; Baltimore VA Medical Center, Baltimore, MD., Marcano I; University of Maryland Medical Center, Baltimore, MD., Lizama S; University of Maryland Medical Center, Baltimore, MD., Gothong C; University of Maryland Medical Center, Baltimore, MD., Munir K; University of Maryland Medical Center, Baltimore, MD., Chesney C; Baltimore VA Medical Center, Baltimore, MD., Maguire R; University of Maryland Medical Center, Baltimore, MD., Scott WH; Baltimore VA Medical Center, Baltimore, MD., Perez-Guzman MC; Emory University School of Medicine, Atlanta, GA., Cardona S; Emory University School of Medicine, Atlanta, GA., Peng L; Emory University Rollins School of Public Health, Atlanta, GA., Umpierrez GE; Emory University School of Medicine, Atlanta, GA.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2022 Oct 01; Vol. 45 (10), pp. 2369-2375.
DOI:	10.2337/dc22-0716
Abstrakt:	Objective: The efficacy and safety of continuous glucose monitoring (CGM) in adjusting inpatient insulin therapy have not been evaluated. Research Design and Methods: This randomized trial included 185 general medicine and surgery patients with type 1 and type 2 diabetes treated with a basal-bolus insulin regimen. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with insulin dose adjusted based on POC results, while in the CGM group, insulin adjustment was based on daily CGM profile. Primary end points were differences in time in range (TIR; 70-180 mg/dL) and hypoglycemia (<70 mg/dL and <54 mg/dL). Results: There were no significant differences in TIR (54.51% ± 27.72 vs. 48.64% ± 24.25; P = 0.14), mean daily glucose (183.2 ± 40 vs. 186.8 ± 39 mg/dL; P = 0.36), or percent of patients with CGM values <70 mg/dL (36% vs. 39%; P = 0.68) or <54 mg/dL (14 vs. 24%; P = 0.12) between the CGM-guided and POC groups. Among patients with one or more hypoglycemic events, compared with POC, the CGM group experienced a significant reduction in hypoglycemia reoccurrence (1.80 ± 1.54 vs. 2.94 ± 2.76 events/patient; P = 0.03), lower percentage of time below range <70 mg/dL (1.89% ± 3.27 vs. 5.47% ± 8.49; P = 0.02), and lower incidence rate ratio <70 mg/dL (0.53 [95% CI 0.31-0.92]) and <54 mg/dL (0.37 [95% CI 0.17-0.83]). Conclusions: The inpatient use of real-time Dexcom G6 CGM is safe and effective in guiding insulin therapy, resulting in a similar improvement in glycemic control and a significant reduction of recurrent hypoglycemic events compared with POC-guided insulin adjustment. (© 2022 by the American Diabetes Association.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu