Glucose as the 5th Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a non-ICU Hospital Setting

Abstract

OBJECTIVE: The current standard for hospital glucose management is point-of-care (POC) testing. We conducted a randomized controlled trial comparing real-time CGM (RT-CGM) to POC in a non-ICU hospital setting. <p>RESEARCH DESIGN AND METHODS: <i>N</i>=110 adults with type 2 diabetes (T2D) on a non-ICU floor received RT-CGM with Dexcom G6 vs usual care (UC). RT-CGM data were wirelessly transmitted from the bedside. Hospital telemetry monitored RT-CGM data and notified bedside nursing of glucose alerts and trends. Standardized protocols were used for interventions.</p> <p>RESULTS: The RT-CGM group demonstrated significantly lower mean glucose (M∆= -18.5 mg/dL) and percentage of time in hyperglycemia >250 mg/dL (-11.41%), and higher median TIR 70-250 mg/dL (+11.26%) compared with UC (<i>p</i>s<0.05). Percentage of time in hypoglycemia was very low. </p> <p>CONCLUSION: RT-CGM can be used successfully in community-based hospital non-ICU settings to improve glucose management; continuously streaming glucose readings may truly be the 5<sup>th</sup> vital sign.</p>

Does continuous glucose monitoring in patients with type 2 diabetes lead to less hypoglycemic events while hospitalized?

“…A 2020 RCT (n=110) compared real-time CGM with POC capillary glucose measurements in hospitalized patients with DM-2 comparing mean glucose and hypoglycemic events. 2 Adults with DM-2, mean six years old, with at least three POC or serum glucose values >200 mg/dL within 24 hours of admission were included in the study. Patients admitted to the intensive care unit or requiring intravenous insulin were excluded.…”