Continuous Glucose Monitoring-Guided Insulin Administration in Long-Term Care Facilities : A Randomized Clinical Trial
Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of the American Medical Directors Association - (2024) vom: 06. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Idrees, Thaer [VerfasserIn] |
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| Links: |
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| Themen: |
CGM |
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| Anmerkungen: |
Date Revised 20.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.jamda.2024.01.031 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369506707 |
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| 245 | 1 | 0 | |a Continuous Glucose Monitoring-Guided Insulin Administration in Long-Term Care Facilities |b A Randomized Clinical Trial |
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| 500 | |a Date Revised 20.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: To evaluate the efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF) | ||
| 520 | |a DESIGN: Prospective randomized clinical trial | ||
| 520 | |a SETTINGS AND PARTICIPANTS: Insulin-treated patients with type 2 diabetes (T2D) admitted to LTCF | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Continuous glucose monitoring | |
| 650 | 4 | |a diabetes mellitus | |
| 650 | 4 | |a hospital | |
| 650 | 4 | |a nursing home | |
| 650 | 4 | |a skilled nursing facility | |
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| 700 | 1 | |a Oh, Hyungseok D |e verfasserin |4 aut | |
| 700 | 1 | |a Gavaller, Monica D |e verfasserin |4 aut | |
| 700 | 1 | |a Zabala, Zohyra |e verfasserin |4 aut | |
| 700 | 1 | |a Moreno, Emmelin |e verfasserin |4 aut | |
| 700 | 1 | |a Moazzami, Bobak |e verfasserin |4 aut | |
| 700 | 1 | |a Galindo, Rodolfo J |e verfasserin |4 aut | |
| 700 | 1 | |a Vellanki, Priyathama |e verfasserin |4 aut | |
| 700 | 1 | |a Cabb, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Theodore M |e verfasserin |4 aut | |
| 700 | 1 | |a Peng, Limin |e verfasserin |4 aut | |
| 700 | 1 | |a Umpierrez, Guillermo E |e verfasserin |4 aut | |
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