Continuous Glucose Monitoring Versus Capillary Point-of-Care Testing for Inpatient Glycemic Control in Type 2 Diabetes Patients Hospitalized in the General Ward and Treated With a Basal Bolus Insulin Regimen

Abstract

BackgroundInpatient dysglycemia, including hyperglycemia, hypoglycemia, and increased glycemic variability, is associated with an increase in hospital-related complications and mortality. 1 Hyperglycemia in diabetic patients hospitalized in the general ward, surgical units, [2][3][4][5] or the intensive care unit 6 is associated with poor clinical outcomes, including longer hospital stay and higher deconditioning, sepsis, and mortality rates. Therefore, optimization of glycemic control in hospitalized patients has been proposed as a necessary and cost-effective strategy. 6 However, implementation of an intensive glucose management program increases the risk of hypoglycemia. Background: Continuous glucose monitoring (CGM) may improve the management of patients with type 2 diabetes hospitalized in the general ward by facilitating the detection of hyper-and hypoglycemic episodes. However, the lack of data on the accuracy and safety of CGM have limited its application.Methods: A prospective pilot study was conducted including 38 patients hospitalized in the general ward with a known diagnosis of type 2 diabetes mellitus (DM) and hyperglycemic individuals without a history of DM with a blood sugar of 140-400 mg on admission treated with a basal bolus insulin regimen. Inpatient glycemic control and the incidence of hypoglycemic episodes were compared between detection by CGM of interstitial fluid for up to 6 days and point-of-care (POC) capillary blood glucose monitoring performed pre-and postprandially, before bedtime and at 3 am.Results: No differences in average daily glucose levels were observed between CGM and POC (176.2 ± 33.9 vs 176.6 ± 33.7 mg/dl, P = .828). However, CGM detected a higher number of hypoglycemic episodes than POC (55 vs 12, P < .01). Glucose measurements were clinically valid, with 91.9% of patients falling within the Clarke error grid A and B zones. Conclusions:Our preliminary results indicate that the use of CGM in type 2 patients hospitalized in the general ward provides accurate estimation of blood sugar levels and is more effective than POC for the detection of hypoglycemic episodes and asymptomatic hypoglycemia.

Round Table Discussion on Inpatient Use of Continuous Glucose Monitoring at the International Hospital Diabetes Meeting

“…To start off the discussion, Dr Umpierrez shared the results of a study that his group performed which compared inpatient glycemic control by CGM versus capillary point-of-care (POC) testing in general medicine patients with type 2 diabetes. 24 The results show that, in general, there was no differences in mean daily glucose, premeal, fasting, or 2-hour postprandial BG between the 2 groups. However, CGM was able to recognize a higher number of hypoglycemic events compared to POC testing in insulin-treated patients.…”

Clinical Use of Continuous Glucose Monitoring in Adults with Type 2 Diabetes

“…Furthermore, this study suggests a possible role for CGM use in the inpatient setting, which has been of increasing interest. 19 …”

Newer Modalities in the Treatment of Type 2 Diabetes Mellitus: Focus on Technology

“…This indicates that CGM can be useful in high-risk Type 2 DM populations such as the elderly, those with special needs and individuals that have difficulty utilizing HGM such as severe arthritic conditions, vascular issues, etc. [33][34][35][36].…”