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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
Open accessAbstract
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 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]
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“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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“250mg/dLaswell as time in range (TIR) 70–180 mg/dL (23).”
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Metadata
- 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.
- 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
- 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
- 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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