140-LB: Management of Inpatient Hyperglycemia Guided by Continuous Glucose Monitoring (CGM) in Insulin-Treated Patients with Diabetes—A Randomized Clinical Trial

Abstract

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. Disclosure I. Spanakis: Other Relationship; Dexcom, Inc. L. G. Singh: None. C. Gothong: None. I. Marcano: None. S. Lizama: None. K. M. Munir: None. C. Chesney: None. R. D. Maguire: None. W. H. Scott: None. L. Peng: None. G. E. Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. M. A. Urrutia: None. M. F. Scioscia: None. R. J. Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. P. Vellanki: n/a. A. L. Migdal: None. G. Davis: Consultant; Medscape, Research Support; Insulet Corporation. T. Idrees: None. F. J. Pasquel: Consultant; AI Health LLC, Boehringer Ingelheim International GmbH, Dexcom, Inc., Research Support; Dexcom, Inc., Insulet Corporation, Merck & Co., Inc.