Reducing inpatient hypoglycemia in the general wards using real-time continuous glucose monitoring: The glucose telemetry system, a randomized clinical trial

Singh, Lakshmi G.; Satyarengga, Medha; Marcano, Isabel; Scott, William H.; Pinault, Lillian F.; Feng, Zhaoyong; Sorkin, John D.; Umpierrez, Guillermo E.; Spanakis, Elias K.

doi:10.2337/dc20-0840

Cited by 154Diabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Treatment and Management

Reducing inpatient hypoglycemia in the general wards using real-time continuous glucose monitoring: The glucose telemetry system, a randomized clinical trial

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Singh, Lakshmi G., Satyarengga, Medha, Marcano, Isabel, Scott, William H., Pinault, Lillian F., Feng, Zhaoyong, Sorkin, John D., Umpierrez, Guillermo E. +1 more·2020·Diabetes Care

DOI 10.2337/dc20-0840PMC PMC7576426

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Abstract

OBJECTIVE: Use of real-time continuous glucose monitoring (RT-CGM) systems in the inpatient setting is considered investigational. The objective of this study was to evaluate whether RT-CGM, using the glucose telemetry system (GTS), can prevent hypoglycemia in the general wards. RESEARCH DESIGN AND METHODS: In a randomized clinical trial, insulin-treated patients with type 2 diabetes at high risk for hypoglycemia were recruited. Participants were randomized to RT-CGM/GTS or point-of-care (POC) blood glucose testing. The primary outcome was difference in inpatient hypoglycemia. RESULTS: Seventy-two participants were included in this interim analysis, 36 in the RT-CGM/GTS group and 36 in the POC group. The RT-CGM/GTS group experienced fewer hypoglycemic events (<70 mg/dL) per patient (0.67 [95% CI 0.34–1.30] vs. 1.69 [1.11–2.58], P = 0.024), fewer clinically significant hypoglycemic events (<54 mg/dL) per patient (0.08 [0.03–0.26] vs. 0.75 [0.51–1.09], P = 0.003), and a lower percentage of time spent below range <70 mg/dL (0.40% [0.18–0.92%] vs. 1.88% [1.26–2.81%], P = 0.002) and <54 mg/dL (0.05% [0.01–0.43%] vs. 0.82% [0.47–1.43%], P = 0.017) compared with the POC group. No differences in nocturnal hypoglycemia, time in range 70–180 mg/dL, and time above range >180–250 mg/dL and >250 mg/dL were found between the groups. The RT-CGM/GTS group had no prolonged hypoglycemia compared with 0.20 episodes <54 mg/dL and 0.40 episodes <70 mg/dL per patient in the POC group. CONCLUSIONS: RT-CGM/GTS can decrease hypoglycemia among hospitalized high-risk insulin-treated patients with type 2 diabetes.

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Recent evidence suggests that adding GLP-1 RAs at discharge for selected patients with uncontrolled T2D may improve glycemic control, reduce hypoglycemia, and cause weight loss compared with adding basal insulin.
“Recent evidence suggests that adding GLP-1 RAs at discharge to select persons with uncontrolled T2D may result in better glycemic control, less hypoglycemia, and weight loss compared with adding basal insulin.1381”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1381]
The Study Procedures describe basal–bolus insulin during hospitalization, and the Conclusions attribute reduced inpatient hypoglycemia to real-time glucose monitoring and a prevention protocol. A search for GLP-1 receptor agonists at discharge and for weight-loss outcomes found no comparison with adding basal insulin; the Results mention GLP-1 receptor agonists only as part of some participants’ treatment before admission. No passage addresses the claimed discharge-treatment benefits. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Studies assessing effectiveness of inpatient CGM may ultimately lead to approved use of CGM for monitoring hospitalized individuals.
“Studies have been published assessing the effectiveness of this approach, which may ultimately lead to the approved use of CGM for monitoring hospitalized individuals (277,286-295).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [294]

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The Need for Data Standards and Implementation Policies to Integrate CGM Data into the Electronic Health Record
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Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital
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CGM in the Hospital: Is It Ready for Prime Time?
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Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery
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2025 Clinical Practice Guidelines for Diabetes Management in Korea: Recommendation of the Korean Diabetes Association
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Accuracy of continuous glucose monitoring in the hospital setting: an observational study
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Continuous Glucose Monitoring in the Intensive Care Unit
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Perioperative Care of Patients Using Wearable Diabetes Devices
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The Launch of the iCoDE Standard Project
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Accuracy and Glycemic Efficacy of Continuous Glucose Monitors in Critically Ill COVID-19 Patients: A Retrospective Study
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How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit
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Practical implementation of remote continuous glucose monitoring in hospitalized patients with diabetes
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Pediatric Endocrinology in the Time of COVID-19: Considerations for the Rapid Implementation of Telemedicine and Management of Pediatric Endocrine Conditions
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A systematic scoping review of just-in-time, adaptive interventions finds limited automation and incomplete reporting
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COVID-19 and Diabetes
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Continuous glucose monitoring-guided insulin administration in long-term care facilities: a randomized clinical trial
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Expanding the horizon of continuous glucose monitoring into the future of pediatric medicine
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Hypoglycemia in patients with type 2 diabetes mellitus during hospitalization: associated factors and prognostic value
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Impact of COVID-19 on Health Economics and Technology of Diabetes Care: Use Cases of Real-Time Continuous Glucose Monitoring to Transform Health Care During a Global Pandemic
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Real-Time Continuous Glucose Monitoring in the Hospital: A Real-World Experience
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Just Because You Can, Doesn't Mean You Should … Now. A Practical Approach to Counseling Persons with Diabetes on Use of Optional CGM Alarms
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Efficacy of Hybrid Closed-Loop Insulin Delivery System in a Hospital Setting: A Case Series
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Implementation Strategies for Inpatient Continuous Glucose Monitoring-based Diabetes Management: A Systematic Review
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The Performance of Continuous Glucose Monitoring During the Intraoperative Period: A Scoping Review
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Continuous Glucose Monitoring for Hyperglycemia in Critically Ill Patients
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The Devil Is in the Details: Use, Limitations, and Implementation of Continuous Glucose Monitoring in the Inpatient Setting
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Diabetesmanagement im Krankenhaus (Update 2023)
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Toward Automation: The Road Traveled and Road Ahead for Integrating Automated Insulin Delivery into Inpatient Care
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Randomized Study Comparing Continuous Glucose Monitoring and Capillary Glucose Testing in Patients With Type 2 Diabetes After Hospital Discharge
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Use of a Continuous Glucose Monitoring System in High-Risk Hospitalized Noncritically Ill Patients With Diabetes After Cardiac Surgery and During Their Transition of Care From the Intensive Care Unit During COVID-19: A Pilot Study
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Review Article – Diabetes Technology in the Hospital: An Update
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Real-time continuous glucose monitoring-guided glucose management in inpatients with diabetes receiving short-term continuous subcutaneous insulin infusion: a randomized clinical trial
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Gaps in our knowledge of managing inpatient dysglycaemia and diabetes in non‐critically ill adults: A call for further research
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Attitudes and behaviors with diabetes technology use in the hospital: multicenter survey study in the United States
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Effectiveness of Continuous Glucose Monitoring on Short-Term, In-Hospital Mortality Among Frail and Critically Ill Patients With COVID-19: Randomized Controlled Trial
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Evaluation of a Continuous Glucose Monitoring–Based Insulin Titration Protocol for Inpatients With Type 2 Diabetes in Non-Intensive Care Unit Settings
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Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial
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Remote Glucose Monitoring Platform for Multiple Simultaneous Patients at Coronavirus Disease 2019 Intensive Care Units: Case Report Including Adults and Children
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Accuracy of intermittently scanned continuous glucose monitoring during caesarean delivery in pregnant women with insulin-treated diabetes
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Systematic Review of Continuous Glucose Monitor Accuracy in the Hypoglycemia Range for Non-Critical Care Ward Hospitalized People Living With Diabetes
Prince, N., Ramsay, T., Shorr, R., RABASA-LHORET, R. P. R., & Sun, C. (2026) · Journal of Diabetes Science and Technology · doi:10.1177/19322968251412482 · Cited by 7 · see citing works
Hypoglycemia symptoms are reduced in hospitalized patients with diabetes
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Inpatient diabetes management
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Criteria for Personalised Choice of a Continuous Glucose Monitoring System: An Expert Opinion
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Satisfaction with continuous glucose monitoring and diabetes care among hospitalised patients with type 2 diabetes managed by inpatient diabetes teams
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Diabetes Technology Use in Special Populations: A Narrative Review of Psychosocial Factors
Hughes, M. S., Aleppo, G., Bally, L., Batista, A. F. M. B., Brown, S. A., Faulds, E. R., Gonder-Frederick, L. A., Isaacs, D. M., Kahkoska, A. R., Ortega, J., et al. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241296853 · Cited by 6 · see citing works
Trends and Disparities in Rates of Hypoglycemia Among Hospitalized Patients With Type 2 Diabetes
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Are we Ready for Real-Time Continuous Glucose Monitoring in the Hospital Setting? Benefits, Challenges, and Practical Approaches for Implementation
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Continuous Glucose Monitoring in Hospitalized Patients With Type 2 Diabetes: A Step Forward in Inpatient Glycemic Control
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Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK
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Addressing Inequity in Continuous Glucose Monitoring Access: Leveraging the Hospital in the Continuum of Care
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Adjustment of Maternal Variable Rate Insulin Infusions Using Real-Time Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes
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Evaluation of a hybrid protocol using continuous glucose monitoring and point-of-care testing in non–critically ill patients in a community hospital
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Ward monitoring 4.0: real-time metabolic insights from continuous glucose monitoring into perioperative organ dysfunction
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1246-P: Reducing Hypoglycemia in the Noncritical Care Setting Using CGM Devices: The Glucose Telemetry System
Spanakis, E. K., Satyarengga, M., Singh, L. G., Pinault, L. F., Sorkin, J. D., Zhan, M., & Umpierrez, G. E. (2019) · Diabetes · doi:10.2337/db19-1246-p
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The Effect of Continuous Glucose Monitoring in Preventing Inpatient Hypoglycemia in General Wards: The Glucose Telemetry System
Spanakis, E. K., Levitt, D. L., Siddiqui, T., Singh, L. G., Pinault, L. F., Sorkin, J. D., Umpierrez, G. E., & Fink, J. C. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817748964 · Cited by 68 · see citing works
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Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), it's time to give more credits to patients’ voice in research: the example of assessing hypoglycemia burden
Wu, Z., Bandini, A., Brazeau, A., & RABASA-LHORET, R. P. R. (2022) · Diabetes & Metabolism · doi:10.1016/j.diabet.2022.101417 · Cited by 16 · see citing works
Continuous glucose monitoring-guided insulin administration in hospitalized patients with diabetes: a randomized clinical trial
Spanakis, E. K., Urrutia, A., Galindo, R. J., Vellanki, P., Migdal, A. L., Davis, G., Fayfman, M., Idrees, T., Pasquel, F. J., Coronado, W. Z., et al. (2022) · Diabetes Care · doi:10.2337/dc22-0716 · Cited by 153 · see citing works
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649-P: Real-Time Continuous Glucose Monitoring in the Hospital Identifies and Prompts Treatment for Hypoglycemia
Baker, M., & WELSH, J. (2022) · Diabetes · doi:10.2337/db22-649-p · Cited by 1 · see citing works

Authors: Singh, L. G., Satyarengga, M., Marcano, I., Scott, W. H., Pinault, L. F., Feng, Z., Sorkin, J. D., Umpierrez, G. E., & Spanakis, E. K.
Affiliations: Baltimore VA Medical Center (US)
Center for Diabetes and Endocrinology, University of Maryland Shore Regional Health, Easton, MD
University of Maryland, Baltimore (US)
Emory University (US)
Corresponding author: Spanakis, Elias K.
ORCID: Satyarengga, Medha
Pinault, Lillian F.
Sorkin, John D.
Umpierrez, Guillermo E.
Spanakis, Elias K.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2020-08-05
Volume: 43
Issue: 11
Pages: 2736-2743
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc20-0840
PMC: PMC7576426
OpenAlex: W3047317123
Cited by: 154
References: 35
Citations by year: 2026: 18 · 2025: 24 · 2024: 31 · 2023: 19 · 2022: 26 · 2021: 27 · 2020: 9
FWCI: 15.27
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.diabetesjournals.org/content/license (vor, 76 d)
Locations: Diabetes Care (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Veterans Affairs Clinical Sciences Research and Development Service (VA MERIT award (#1I01CX001825))
VA Medical Center GRECC
National Institute on Aging
National Institute of Diabetes and Digestive and Kidney Diseases (DK-072488)
National Institutes of Health (UL1-TR-002378, P30-DK-111024)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: real-time continuous glucose monitoring, type 2 diabetes, insulin-treated patients, nocturnal hypoglycemia, time in range, hospitalized patients, hypoglycemia prevention

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Reducing inpatient hypoglycemia in the general wards using real-time continuous glucose monitoring: The glucose telemetry system, a randomized clinical trial

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