Endocrine Abstracts

Introduction: Continuous glucose monitoring systems (CGM) have revolutionized the monitoring of diabetes, allowing real-time measurement of interstitial glucose levels. Although these devices are suitable for patients on insulin therapy, they are not yet routinely used in an inpatient setting. The difficulty observed in the glycemic control of hospitalized patients under intensive insulin therapy led to the development of a protocol to study the application of CGM in these patients.

Aim: Primary endpoint was the increase in the time in range (glycemic readings between 100-180mg/dl) in hospitalized patients with CGM. Secondary endpoint was the reduction in the number of hypoglycemic events.

Methods: Prospective study of 60 hospitalized patients with type 2 diabetes on intensive insulin therapy. Patients were randomized into two groups of 30 individuals: an intervention group monitored through CGM (Freestyle Libre^TM 2) and a control group whose glycemic profile was monitored using point-of-care capillary blood glucose (CBG), with at least three readings per day.

Results: Both groups were similar regarding age (74.4 years vs. 76.8 years, P=0.277), gender (higher prevalence of males, 83.3% vs. 63.3%, P=0.143), diabetes duration (12 years vs. 14 years, P=0.824), diabetes associated complications (assessed using the Diabetes Complications Severity Score; P=0.151) and outpatient treatment (P=0.570). No differences were observed on admission diagnosis (most frequently due to an infectious disease, 53.3% vs. 48.3%, P=0.157), nor regarding the analytical values on admission (namely hemoglobin: 12.6 mg/dl vs. 11, 7 mg/dl, P=0.158, HbA1c: 7.1% vs. 7.2%, P=0.158 and creatinine: 1.4 vs. 1.3, P=0.158). CGM had a positive impact on glycemic control, with more readings per day (6 vs. 4, P<0.001), improved time in range (100-180 mg/dl) (53.5% vs. 36.5%, P=0.032), and less time above range (26% vs. 53%, P=0.008), in particular values above 250 mg/dl (6% vs. 25%, P=0.003). A lower mean glucose (162 mg/dl vs. 207 mg/dl, P<0.001) and lower estimated HbA1c (7.3% vs. 8.8% P=0.001) were also observed in the CGM group, but there was no difference in glycemic variability (34.2% vs. 34.8% P=0.181). Regarding hypoglycemia, the small number of hypoglycemic events per patient in each group did not allow an adequate comparison (CGM 0 (0-5) vs. CBG 0 (0-2); P=0.107). CGM showed no difference in reducing mortality, length of hospital stays, nor infection rate, compared to CBG (P=1.000, P=0.455 and P=0.606, respectively).

Conclusion: The results obtained in this prospective study encourage the use of CGM in optimizing the control of type 2 diabetes during hospitalization.