Continuous glucose monitoring-guided insulin administration in long-term care facilities: a randomized clinical trial
Open accessAbstract
Objectives To evaluate the efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF). Design Prospective randomized clinical trial. Settings and participants Insulin-treated patients with type 2 diabetes (T2D) admitted to LTCF. Methods Participants in the standard of care wore a blinded CGM with treatment adjusted based on point-of-care capillary glucose results before meals and bedtime (POC group). Participants in the intervention (CGM group) wore a Dexcom G6 CGM with treatment adjusted based on daily CGM profile. Treatment adjustment was performed by the LTCF medical team, with a duration of intervention up to 60 days. The primary endpoint was difference in time in range (TIR 70-180 mg/dL) between treatment groups. Results Among 100 participants (age 74.73 ± 11 years, 80% admitted for subacute rehabilitation and 20% for nursing home care), there were no significant differences in baseline clinical characteristics between groups, and CGM data were compared for a median of 17 days. There were no differences in TIR (53.38% ± 30.16% vs 48.81% ± 28.03%, P = .40), mean daily mean CGM glucose (184.10 ± 43.4 mg/dL vs 190.0 ± 45.82 mg/dL, P = .71), or the percentage of time below range (TBR) <70 mg/dL (0.83% ± 2.59% vs 1.18% ± 3.54%, P = .51), or TBR <54 mg/dL (0.23% ± 0.85% vs 0.56% ± 2.24%, P = .88) between rt-CGM and POC groups. Conclusions and implications The use of rtCGM is safe and effective in guiding insulin therapy in patients with T2D in LTCF resulting in a similar improvement in glycemic control compared to POC-guided insulin adjustment.
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In the randomized controlled trial, there were no differences in TIR, time below range, or mean glucose levels.
“There were no differences in TIR, time below range, or mean glucose levels (142).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [142]
A recent randomized controlled trial in LTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.
“Of note, a recent randomized controlled trial in LTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [142]
In the same RCT, there were no differences in TIR, time below range, or mean glucose levels between real-time CGM and BGM.
“There were no differences in TIR, time below range, or mean glucose levels (162).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [162]
A recent RCT in PALTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.
“Of note, a recent RCT in PALTC facilities showed that real-time CGM use for up to 60 days was safe and effective in guiding insulin doses compared with BGM by point of care.”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [162]
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“A recent trial failed to detect improvements of glucose control with CGM in hospitalised elderly patients, 20 in apparent contrast with pre-sent data; however, in that study patients in the control arm received an accurate monitoring of blood glucose, as established by the protocol, and insulin…”
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Diabetes Technology: A Call to Action for Use in Post-Acute and Long-Term Care.
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- Authors
- Idrees, T., Castro-Revoredo, I. A., Oh, H. D., Gavaller, M. D., Zabala, Z., Moreno, E., Moazzami, B., Galindo, R. J., Vellanki, P., Cabb, E., Johnson, T. M., Peng, L., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- ORCID
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2024-05
- Volume
- 25
- Issue
- 5
- Pages
- 884-888
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC11283256
- OpenAlex
- W4392502146
- Cited by
- 22
- References
- 46
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 1
- FWCI
- 7.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Dexcom Inc
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- continuous glucose monitoring, insulin therapy, type 2 diabetes, long-term care facilities, nursing homes, glycemic control, time in range, insulin dose adjustment, older adults
- MeSH terms
- Continuous Glucose Monitoring, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Insulin, Long-Term Care, Male, Middle Aged, Prospective Studies, Blood Glucose Self-Monitoring
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