Hospitals typically perform point-of-care testing to manage the blood glucose levels of their diabetic patients. There are signs that approach is failing a significant minority of diabetic patients. Rates of hyperglycemia in non-critically ill hospitalized patients range from 38% to 46%. Hyperglycemia is linked to complications, mortality and longer stays in the hospital.
The Diabetes Care paper provides an indication of whether the use of CGM devices in hospitals could deliver benefits after the pandemic is over. Investigators randomized 110 adults with Type 2 diabetes to receive either Dexcom G6 or usual care during their stay in the hospital.
Patients in the G6 cohort spent 73% of the time in the 70 to 250 mg/dL range, compared to 64% of people in the standard of care group. Similarly, 33% of patients on standard of care experienced hyperglycemia, as defined by a blood glucose level in excess of 250 mg/dL. The rate in the G6 arm was 27%. The differences in rates of hyperglycemia and time in range were statistically significant.
However, CGM was statistically no better than standard of care at keeping patients in the tighter ranges of 70 to 180 mg/dL and 70 to 200 mg/dL. The hospital where the study took place aims to keep patients in the 100 to 180 mg/dL range and ADA guidelines list 140 to 180 mg/dL as the preferred target.
The failure of the Dexcom sensor to keep more patients in the tighter ranges therefore raises doubts about its value in achieving the targets set by diabetes experts. However, the authors of the Diabetes Care paper said the wider 70 to 250 mg/dL range “was a more realistic target” as patients enrolled in the study “were significantly dysglycemic at admission.”
The authors speculate the failure to improve time in the tighter range “occurred because our interventions were tailored toward giving extra rapid-acting insulin overnight for blood glucose 200 mg/ dL, a time when we otherwise would not be routinely using correction insulin.” Read more
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