140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial
Inpatient use of CGM results in higher detection of hypoglycemic and hyperglycemic events compared to point of care testing (POC) but its efficacy and safety in adjusting insulin therapy has not been evaluated. This randomized controlled trial included 181 general medicine and surgery patients with...
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| creator | SPANAKIS, ILIAS (ELIAS) URRUTIA, MARIA A. SCIOSCIA, MARIA F. GALINDO, RODOLFO J. VELLANKI, PRIYATHAMA MIGDAL, ALEXANDRA L. DAVIS, GEORGIA M. IDREES, THAER PASQUEL, FRANCISCO J. SINGH, LAKSHMI G. GOTHONG, CHIKARA MARCANO, ISABEL LIZAMA, SERGIO MUNIR, KASHIF M. CHESNEY, CATALINA MAGUIRE, REBECCA D. SCOTT, WILLIAM H. PENG, LIMIN UMPIERREZ, GUILLERMO E. |
| description | Inpatient use of CGM results in higher detection of hypoglycemic and hyperglycemic events compared to point of care testing (POC) but its efficacy and safety in adjusting insulin therapy has not been evaluated. This randomized controlled trial included 181 general medicine and surgery patients with type 1 (n= 18) and type 2 (n= 155) diabetes treated with a basal bolus insulin regimen. All patients underwent POC testing AC & HS. Patients in the 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 Dexcom G6 CGM profile review. Hypoglycemia alarms were set at 80 mg/dl in the CGM group. Primary endpoints were differences in time in range (70-180 mg/dl) and hypoglycemia ( |
| doi_str_mv | 10.2337/db22-140-LB |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2685595030</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2685595030</sourcerecordid><originalsourceid>FETCH-LOGICAL-c640-71f6019f84af603265e9585f172d8fd46e52780edb57fdeee5cb1ae0ee36affc3</originalsourceid><addsrcrecordid>eNotUUtOwzAQtRBIlMKKC1hiA0IBO67zYdcGSCu1AqEs2EVOMi6uUrvYiVBZcQhuwM04Ca6KZjEzmvfeaOYhdE7JTchYfNtUYRjQEQnmkwM0oClLAxbGr4doQAj1kziNj9GJcytCSORjgH726Du8EFosYQ26w0bimd6ITu2a6XYDdtlua1grgfNeNdDgaoszozule9M7nLd9bRzghdGqM1bpJb7M8sUVVtoLub5VOigsiM4zn_eyDn-o7g3fK1FBB-7363uMX4RuzFp9elTmKaoWLS6sEu0pOpKidXD2n4eoeHwosmkwf8pn2Xge1JE_IqYyIjSVyUj4goURh5QnXNI4bBLZjCLgYZwQaCoeywYAeF1RAQSARULKmg3RxV52Y817D64rV6a32m8swyjhPOWEEY-63qNqa5yzIMuNVWthtyUl5c6EcmdC6d9azifsD-MrfL8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2685595030</pqid></control><display><type>article</type><title>140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial</title><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>SPANAKIS, ILIAS (ELIAS) ; URRUTIA, MARIA A. ; SCIOSCIA, MARIA F. ; GALINDO, RODOLFO J. ; VELLANKI, PRIYATHAMA ; MIGDAL, ALEXANDRA L. ; DAVIS, GEORGIA M. ; IDREES, THAER ; PASQUEL, FRANCISCO J. ; SINGH, LAKSHMI G. ; GOTHONG, CHIKARA ; MARCANO, ISABEL ; LIZAMA, SERGIO ; MUNIR, KASHIF M. ; CHESNEY, CATALINA ; MAGUIRE, REBECCA D. ; SCOTT, WILLIAM H. ; PENG, LIMIN ; UMPIERREZ, GUILLERMO E.</creator><creatorcontrib>SPANAKIS, ILIAS (ELIAS) ; URRUTIA, MARIA A. ; SCIOSCIA, MARIA F. ; GALINDO, RODOLFO J. ; VELLANKI, PRIYATHAMA ; MIGDAL, ALEXANDRA L. ; DAVIS, GEORGIA M. ; IDREES, THAER ; PASQUEL, FRANCISCO J. ; SINGH, LAKSHMI G. ; GOTHONG, CHIKARA ; MARCANO, ISABEL ; LIZAMA, SERGIO ; MUNIR, KASHIF M. ; CHESNEY, CATALINA ; MAGUIRE, REBECCA D. ; SCOTT, WILLIAM H. ; PENG, LIMIN ; UMPIERREZ, GUILLERMO E.</creatorcontrib><description><![CDATA[Inpatient use of CGM results in higher detection of hypoglycemic and hyperglycemic events compared to point of care testing (POC) but its efficacy and safety in adjusting insulin therapy has not been evaluated. This randomized controlled trial included 181 general medicine and surgery patients with type 1 (n= 18) and type 2 (n= 155) diabetes treated with a basal bolus insulin regimen. All patients underwent POC testing AC & HS. Patients in the 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 Dexcom G6 CGM profile review. Hypoglycemia alarms were set at 80 mg/dl in the CGM group. Primary endpoints were differences in time in range (70-180 mg/dl) and hypoglycemia (<70 mg/dl and <54 mg/dl) .
Results: There were no differences on admission clinical characteristics, HbA1c or diabetes type between POC and CGM groups. There were no differences in mean daily glucose (186.8±39 mg/dl vs. 183.2±40 mg/dl, p=0.36) , total daily insulin dose (36.1±28 U/day vs. 40.7±29 U/day, p=0.33) , % patients with CGM values <70 mg/dl (39% vs. 36%, p=0.68) or <54mg/dl (24% vs. 14%, p=0.12) between the two groups. Among patients with ≥ 1 hypoglycemic event, compared to POC, CGM use resulted in significant reduction in hypoglycemia recurrence with an incidence-ratio for glucose <70mg/dl (0.53, 95% CI:0.31-0.92) and incidence-ratio for glucose <54mg/dl (0.37 (95% CI:0.17-0.83) . The percent time <70 mg/dl among those with hypoglycemia was smaller in the CGM (1.9±3.3% vs. 5.5±8.5, p=0.024) compared to the POC group, with group difference in hypoglycemia confirmed by zero-inflated Beta Regression analysis (p<0.001) .
Conclusion: Our results indicates that the inpatient use of Dexcom G6 CGM is safe and effective in guiding insulin adjustment resulting in similar improvement in glucose control and in significant reduction of recurrent hypoglycemic events compared to POC testing.]]></description><identifier>ISSN: 0012-1797</identifier><identifier>EISSN: 1939-327X</identifier><identifier>DOI: 10.2337/db22-140-LB</identifier><language>eng</language><publisher>New York: American Diabetes Association</publisher><subject>Diabetes ; Diabetes mellitus (non-insulin dependent) ; Glucose ; Glucose monitoring ; Hyperglycemia ; Hypoglycemia ; Insulin ; Patients ; Sensors</subject><ispartof>Diabetes (New York, N.Y.), 2022-06, Vol.71 (Supplement_1)</ispartof><rights>Copyright American Diabetes Association Jun 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>SPANAKIS, ILIAS (ELIAS)</creatorcontrib><creatorcontrib>URRUTIA, MARIA A.</creatorcontrib><creatorcontrib>SCIOSCIA, MARIA F.</creatorcontrib><creatorcontrib>GALINDO, RODOLFO J.</creatorcontrib><creatorcontrib>VELLANKI, PRIYATHAMA</creatorcontrib><creatorcontrib>MIGDAL, ALEXANDRA L.</creatorcontrib><creatorcontrib>DAVIS, GEORGIA M.</creatorcontrib><creatorcontrib>IDREES, THAER</creatorcontrib><creatorcontrib>PASQUEL, FRANCISCO J.</creatorcontrib><creatorcontrib>SINGH, LAKSHMI G.</creatorcontrib><creatorcontrib>GOTHONG, CHIKARA</creatorcontrib><creatorcontrib>MARCANO, ISABEL</creatorcontrib><creatorcontrib>LIZAMA, SERGIO</creatorcontrib><creatorcontrib>MUNIR, KASHIF M.</creatorcontrib><creatorcontrib>CHESNEY, CATALINA</creatorcontrib><creatorcontrib>MAGUIRE, REBECCA D.</creatorcontrib><creatorcontrib>SCOTT, WILLIAM H.</creatorcontrib><creatorcontrib>PENG, LIMIN</creatorcontrib><creatorcontrib>UMPIERREZ, GUILLERMO E.</creatorcontrib><title>140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial</title><title>Diabetes (New York, N.Y.)</title><description><![CDATA[Inpatient use of CGM results in higher detection of hypoglycemic and hyperglycemic events compared to point of care testing (POC) but its efficacy and safety in adjusting insulin therapy has not been evaluated. This randomized controlled trial included 181 general medicine and surgery patients with type 1 (n= 18) and type 2 (n= 155) diabetes treated with a basal bolus insulin regimen. All patients underwent POC testing AC & HS. Patients in the 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 Dexcom G6 CGM profile review. Hypoglycemia alarms were set at 80 mg/dl in the CGM group. Primary endpoints were differences in time in range (70-180 mg/dl) and hypoglycemia (<70 mg/dl and <54 mg/dl) .
Results: There were no differences on admission clinical characteristics, HbA1c or diabetes type between POC and CGM groups. There were no differences in mean daily glucose (186.8±39 mg/dl vs. 183.2±40 mg/dl, p=0.36) , total daily insulin dose (36.1±28 U/day vs. 40.7±29 U/day, p=0.33) , % patients with CGM values <70 mg/dl (39% vs. 36%, p=0.68) or <54mg/dl (24% vs. 14%, p=0.12) between the two groups. Among patients with ≥ 1 hypoglycemic event, compared to POC, CGM use resulted in significant reduction in hypoglycemia recurrence with an incidence-ratio for glucose <70mg/dl (0.53, 95% CI:0.31-0.92) and incidence-ratio for glucose <54mg/dl (0.37 (95% CI:0.17-0.83) . The percent time <70 mg/dl among those with hypoglycemia was smaller in the CGM (1.9±3.3% vs. 5.5±8.5, p=0.024) compared to the POC group, with group difference in hypoglycemia confirmed by zero-inflated Beta Regression analysis (p<0.001) .
Conclusion: Our results indicates that the inpatient use of Dexcom G6 CGM is safe and effective in guiding insulin adjustment resulting in similar improvement in glucose control and in significant reduction of recurrent hypoglycemic events compared to POC testing.]]></description><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Glucose</subject><subject>Glucose monitoring</subject><subject>Hyperglycemia</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Patients</subject><subject>Sensors</subject><issn>0012-1797</issn><issn>1939-327X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNotUUtOwzAQtRBIlMKKC1hiA0IBO67zYdcGSCu1AqEs2EVOMi6uUrvYiVBZcQhuwM04Ca6KZjEzmvfeaOYhdE7JTchYfNtUYRjQEQnmkwM0oClLAxbGr4doQAj1kziNj9GJcytCSORjgH726Du8EFosYQ26w0bimd6ITu2a6XYDdtlua1grgfNeNdDgaoszozule9M7nLd9bRzghdGqM1bpJb7M8sUVVtoLub5VOigsiM4zn_eyDn-o7g3fK1FBB-7363uMX4RuzFp9elTmKaoWLS6sEu0pOpKidXD2n4eoeHwosmkwf8pn2Xge1JE_IqYyIjSVyUj4goURh5QnXNI4bBLZjCLgYZwQaCoeywYAeF1RAQSARULKmg3RxV52Y817D64rV6a32m8swyjhPOWEEY-63qNqa5yzIMuNVWthtyUl5c6EcmdC6d9azifsD-MrfL8</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>SPANAKIS, ILIAS (ELIAS)</creator><creator>URRUTIA, MARIA A.</creator><creator>SCIOSCIA, MARIA F.</creator><creator>GALINDO, RODOLFO J.</creator><creator>VELLANKI, PRIYATHAMA</creator><creator>MIGDAL, ALEXANDRA L.</creator><creator>DAVIS, GEORGIA M.</creator><creator>IDREES, THAER</creator><creator>PASQUEL, FRANCISCO J.</creator><creator>SINGH, LAKSHMI G.</creator><creator>GOTHONG, CHIKARA</creator><creator>MARCANO, ISABEL</creator><creator>LIZAMA, SERGIO</creator><creator>MUNIR, KASHIF M.</creator><creator>CHESNEY, CATALINA</creator><creator>MAGUIRE, REBECCA D.</creator><creator>SCOTT, WILLIAM H.</creator><creator>PENG, LIMIN</creator><creator>UMPIERREZ, GUILLERMO E.</creator><general>American Diabetes Association</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20220601</creationdate><title>140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial</title><author>SPANAKIS, ILIAS (ELIAS) ; URRUTIA, MARIA A. ; SCIOSCIA, MARIA F. ; GALINDO, RODOLFO J. ; VELLANKI, PRIYATHAMA ; MIGDAL, ALEXANDRA L. ; DAVIS, GEORGIA M. ; IDREES, THAER ; PASQUEL, FRANCISCO J. ; SINGH, LAKSHMI G. ; GOTHONG, CHIKARA ; MARCANO, ISABEL ; LIZAMA, SERGIO ; MUNIR, KASHIF M. ; CHESNEY, CATALINA ; MAGUIRE, REBECCA D. ; SCOTT, WILLIAM H. ; PENG, LIMIN ; UMPIERREZ, GUILLERMO E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c640-71f6019f84af603265e9585f172d8fd46e52780edb57fdeee5cb1ae0ee36affc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Glucose</topic><topic>Glucose monitoring</topic><topic>Hyperglycemia</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Patients</topic><topic>Sensors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SPANAKIS, ILIAS (ELIAS)</creatorcontrib><creatorcontrib>URRUTIA, MARIA A.</creatorcontrib><creatorcontrib>SCIOSCIA, MARIA F.</creatorcontrib><creatorcontrib>GALINDO, RODOLFO J.</creatorcontrib><creatorcontrib>VELLANKI, PRIYATHAMA</creatorcontrib><creatorcontrib>MIGDAL, ALEXANDRA L.</creatorcontrib><creatorcontrib>DAVIS, GEORGIA M.</creatorcontrib><creatorcontrib>IDREES, THAER</creatorcontrib><creatorcontrib>PASQUEL, FRANCISCO J.</creatorcontrib><creatorcontrib>SINGH, LAKSHMI G.</creatorcontrib><creatorcontrib>GOTHONG, CHIKARA</creatorcontrib><creatorcontrib>MARCANO, ISABEL</creatorcontrib><creatorcontrib>LIZAMA, SERGIO</creatorcontrib><creatorcontrib>MUNIR, KASHIF M.</creatorcontrib><creatorcontrib>CHESNEY, CATALINA</creatorcontrib><creatorcontrib>MAGUIRE, REBECCA D.</creatorcontrib><creatorcontrib>SCOTT, WILLIAM H.</creatorcontrib><creatorcontrib>PENG, LIMIN</creatorcontrib><creatorcontrib>UMPIERREZ, GUILLERMO E.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Diabetes (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SPANAKIS, ILIAS (ELIAS)</au><au>URRUTIA, MARIA A.</au><au>SCIOSCIA, MARIA F.</au><au>GALINDO, RODOLFO J.</au><au>VELLANKI, PRIYATHAMA</au><au>MIGDAL, ALEXANDRA L.</au><au>DAVIS, GEORGIA M.</au><au>IDREES, THAER</au><au>PASQUEL, FRANCISCO J.</au><au>SINGH, LAKSHMI G.</au><au>GOTHONG, CHIKARA</au><au>MARCANO, ISABEL</au><au>LIZAMA, SERGIO</au><au>MUNIR, KASHIF M.</au><au>CHESNEY, CATALINA</au><au>MAGUIRE, REBECCA D.</au><au>SCOTT, WILLIAM H.</au><au>PENG, LIMIN</au><au>UMPIERREZ, GUILLERMO E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial</atitle><jtitle>Diabetes (New York, N.Y.)</jtitle><date>2022-06-01</date><risdate>2022</risdate><volume>71</volume><issue>Supplement_1</issue><issn>0012-1797</issn><eissn>1939-327X</eissn><abstract><![CDATA[Inpatient use of CGM results in higher detection of hypoglycemic and hyperglycemic events compared to point of care testing (POC) but its efficacy and safety in adjusting insulin therapy has not been evaluated. This randomized controlled trial included 181 general medicine and surgery patients with type 1 (n= 18) and type 2 (n= 155) diabetes treated with a basal bolus insulin regimen. All patients underwent POC testing AC & HS. Patients in the 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 Dexcom G6 CGM profile review. Hypoglycemia alarms were set at 80 mg/dl in the CGM group. Primary endpoints were differences in time in range (70-180 mg/dl) and hypoglycemia (<70 mg/dl and <54 mg/dl) .
Results: There were no differences on admission clinical characteristics, HbA1c or diabetes type between POC and CGM groups. There were no differences in mean daily glucose (186.8±39 mg/dl vs. 183.2±40 mg/dl, p=0.36) , total daily insulin dose (36.1±28 U/day vs. 40.7±29 U/day, p=0.33) , % patients with CGM values <70 mg/dl (39% vs. 36%, p=0.68) or <54mg/dl (24% vs. 14%, p=0.12) between the two groups. Among patients with ≥ 1 hypoglycemic event, compared to POC, CGM use resulted in significant reduction in hypoglycemia recurrence with an incidence-ratio for glucose <70mg/dl (0.53, 95% CI:0.31-0.92) and incidence-ratio for glucose <54mg/dl (0.37 (95% CI:0.17-0.83) . The percent time <70 mg/dl among those with hypoglycemia was smaller in the CGM (1.9±3.3% vs. 5.5±8.5, p=0.024) compared to the POC group, with group difference in hypoglycemia confirmed by zero-inflated Beta Regression analysis (p<0.001) .
Conclusion: Our results indicates that the inpatient use of Dexcom G6 CGM is safe and effective in guiding insulin adjustment resulting in similar improvement in glucose control and in significant reduction of recurrent hypoglycemic events compared to POC testing.]]></abstract><cop>New York</cop><pub>American Diabetes Association</pub><doi>10.2337/db22-140-LB</doi></addata></record> |
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| subjects | Diabetes Diabetes mellitus (non-insulin dependent) Glucose Glucose monitoring Hyperglycemia Hypoglycemia Insulin Patients Sensors |
| title | 140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial |
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