Dexcom G6 Observational Study

August 3, 2021 updated by: Guillermo Umpierrez, MD, Emory University

Inpatient and Post-hospital Discharge Assessment of Glycemic Control by Capillary Point-of-care Glucose Testing and by Continuous Glucose Monitoring in Insulin-treated Patients With Type 1 and Type 2 Diabetes: Dexcom G6 Observational Study

This is an exploratory prospective study primary aiming to evaluate differences between Point-of-care (POC) testing (standard of care) and Dexcom G6 CGM (Continues Glucose Monitoring sensor system) in 1) glycemic control measured by mean daily blood glucose and 2) identifying hypoglycemic and hyperglycemic events - in patients with type 1 and type 2 diabetes treated with basal bolus insulin regimen.

Study Overview

Detailed Description

Several studies have shown that the use of a device that can measure blood glucose levels every 5 minutes is more effective in identifying low blood glucose (hypoglycemia) and high blood glucose (hyperglycemia) when compared to regular measurements with fingersticks [point of care (POC)].

This is an exploratory prospective study primary aiming to evaluate differences between Point-of-care (POC) testing (standard of care) and Dexcom G6 CGM (Continues Glucose Monitoring sensor system) in 1) glycemic control measured by mean daily blood glucose and 2) identifying hypoglycemic and hyperglycemic events - in patients with type 1 and type 2 diabetes treated with basal bolus insulin regimen.

Study Type

Interventional

Enrollment (Actual)

101

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Georgia
      • Atlanta, Georgia, United States, 30322
        • Emory University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. > 18 years admitted to a general medicine or surgical service.
  2. Known history of T1D or T2D receiving insulin therapy
  3. Subjects must have a randomization BG between 140 mg and 400 mg/dL without laboratory evidence of diabetic ketoacidosis (bicarbonate < 18 mEq/L, pH < 7.30, or positive serum or urinary ketones).
  4. Patients with expected hospital length-of-stay of 3 or more days

Exclusion Criteria:

  1. Patients with acute illness admitted to the ICU or expected to require admission to the ICU.
  2. Patients expected to require MRI procedures during hospitalization.
  3. Mental condition rendering the subject unable to understand the nature, scope, and possible consequences of the study.
  4. Female subjects who are pregnant or breast-feeding at time of enrollment into the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: DIAGNOSTIC
  • Allocation: NA
  • Interventional Model: SINGLE_GROUP
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Dexcom G6 CGM - Continues Glucose Monitoring sensor system

The Dexcom G6 CGM is a commercially available factory-calibrated sensor system. The system measures interstitial glucose every 5-15 minutes, providing real-time and more complete glycemic profile during 24-hours compared to standard POC glucose testing, and replaces the need for finger sticking. Potential limitations include the need for removing the sensor before MRI or diathermy treatment, and the potential interference in patients with severe dehydration.

In parallel, same participants will be monitored by the standard of care point-of-care (POC) capillary glucose tests. Diabetes guidelines recommend bedside capillary POC testing before meals and at bedtime to assess glycemic control and to adjust insulin therapy in the hospital.

A blinded factory-calibrated continues glucose monitoring sensor system Dexcom G6 will be placed shortly after admission. Two CGM devices will be inserted in all patients - one in the abdomen and one in the arm to also assess differences in blood glucose readings between upper extremity and abdominal insertion sites. Information on CGM readings will be collected daily during the hospital stay and after hospital discharge for 10 days using the Dexcom Studio software to download the Dexcom receiver data.
Standard of care - bedside point-of-care (POC) capillary blood glucose (BG) monitoring will be done before meals and bedtime daily during the hospital stay and after hospital discharge for 10 days.
Other Names:
  • Standard of Care capillary glucose test

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean Daily Blood Glucose by POC Reading сompared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Mean daily blood glucose will be calculated
During hospital stay (3 days - up to 30 days)
Number of Clinical Significant Hypoglycemia (<54 mg/dl) Events by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of clinical significant hypoglycemia (<54 mg/dl) events will be calculated
During hospital stay (3 days - up to 30 days)
Number of Severe Hyperglycemia (>240 mg/dl) Events by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of severe hyperglycemia (>240 mg/dl) events will be recorded
During hospital stay (3 days - up to 30 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean Daily Blood Glucose by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Mean daily blood glucose will be calculated
10 days post discharge
Number of Clinical Significant Hypoglycemia (<54 mg/dl) Events by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of clinical significant hypoglycemia (<54 mg/dl) events will be calculated
10 days post discharge
Number of Clinical Significant Severe Hyperglycemia (>240 mg/dl) Events by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of severe hyperglycemia (>240 mg/dl) events will be recorded
10 days post discharge
Number of Nocturnal Hypoglycemic Events < 70 mg/dl (Between 22:00 and 06:00) by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of nocturnal hypoglycemic events < 70 mg/dl (between 22:00 and 06:00) will be recorded
During hospital stay (3 days - up to 30 days)
Number of Nocturnal Hypoglycemic Events < 70 mg/dl (Between 22:00 and 06:00) by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of nocturnal hypoglycemic events < 70 mg/dl(between 22:00 and 06:00) will be recorded
10 days post discharge
Number of of Hypoglycemic Events < 70mg/dl in POC Group by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of of hypoglycemic events < 70mg/dl will be recorded
During hospital stay (3 days - up to 30 days)
Number of Hypoglycemic Events < 70mg/dl by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of of hypoglycemic events < 70mg/dl will be recorded
10 days post discharge
Time in Hypoglycemia (Minutes) During the Day and Night by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Time in hypoglycemia (minutes) during the day and night will be recorded. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range. .
During hospital stay (3 days - up to 30 days)
Time in Hypoglycemia (Minutes) During the Day and Night by CGM Reading
Time Frame: 10 days post discharge
Time in hypoglycemia (minutes) during the day and night will be recorded. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range. .
10 days post discharge
Time in Hyperglycemia (Minutes) During the Day and Night> 240 mg/dl by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Time in hyperglycemia (minutes) during the day and night> 240 mg/dl will be recorded. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range. .
During hospital stay (3 days - up to 30 days)
Time in Hyperglycemia (Minutes) During the Day and Night> 240 mg/dl by CGM Reading
Time Frame: 10 days post discharge
Time in hyperglycemia (minutes) during the day and night> 240 mg/dl will be recorded. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range.
10 days post discharge
Number of Hyperglycemic Events > 240 mg/dl by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of hyperglycemic events > 240 mg/dl will be recorded
During hospital stay (3 days - up to 30 days)
Number of Hyperglycemic Events > 240 mg/dl by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of hyperglycemic events > 240 mg/dl will be recorded
10 days post discharge
Percentage of BG Readings Within Target BG of 70 and 180 mg/dl by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of BG readings within target BG of 70 and 180 mg/dl will be calculated
During hospital stay (3 days - up to 30 days)
Percentage of BG Readings Within Target BG of 70 and 180 mg/dl by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Percentage of BG readings within target BG of 70 and 180 mg/dl will be calculated
10 days post discharge
Percentage of Patients With Greater Than 5%-Time Below Glucose Target <70mg/dl by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of patients with greater than 5%-time below glucose target <70mg/dl will be calculated. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range.
During hospital stay (3 days - up to 30 days)
Percentage of Patients With Greater Than 5%-Time Below Glucose Target <70 mg/dl by CGM Reading
Time Frame: 10 days post discharge
Percentage of patients with greater than 5%-time below glucose target <70 mg/dl will be calculated
10 days post discharge
Percentage of Patients With Greater Than 5%-Time Above Glucose Target >180mg/dl by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of patients with greater than 5%-time above glucose target >180 mg/dl will be calculated
During hospital stay (3 days - up to 30 days)
Percentage of Patients With Greater Than 5%-Time Above Glucose Target >180 mg/dl by CGM Reading
Time Frame: 10 days post discharge
Percentage of patients with greater than 5%-time above glucose target >180 will be calculated
10 days post discharge
Glycemic Variability Calculated by Standard Deviation by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Glycemic variability will be calculated using Standard Deviation
During hospital stay (3 days - up to 30 days)
Glycemic Variability Calculated by MAGE by CGM Reading
Time Frame: 10 days post discharge
MAGE: average amplitude of glycemic excursions with values exceeding a certain threshold.
10 days post discharge
Number of Sensor Removal/Failures/Dislodgments
Time Frame: During hospital stay (3 days - up to 30 days)
Number of sensor removal/failures/dislodgments will be recorded
During hospital stay (3 days - up to 30 days)
Mean Absolute Relative Difference (MARD) of CGM Compared to POC
Time Frame: During hospital stay (3 days - up to 30 days)
Accuracy of Dexcom G6 CGM, as defined by overall MARD, compared to POC
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 30/30% for Values < 70 mg/d Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hypoglycemic range (<70 mg/dl) meeting %30/30 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Values Within Zone A, B, C, D of the Clarke Error Grid Measured in Abdomen
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within defined performance zones (A-E) indicating potential for clinical error. The Clarke error grid analysis uses a Cartesian diagram, in which the estimated/predicted values are displayed on the y-axis, whereas the reference values are presented on the x-axis. This diagram is subdivided into 5 zones: A, B, C, D, and E. The points that fall within zones A and B represent, respectively, sufficiently accurate and acceptable glucose results (better outcome), points in zone C may prompt unnecessary corrections, points in zones D and E represent erroneous and incorrect treatment.
During hospital stay (3 days - up to 30 days)
Percentage of Values Within Zone A, B, C of the Clarke Error Grid Measured in Arm
Time Frame: During hospital stay (3 days - up to 30 days) measured in arm
Percentage of CGM glucose values within defined performance zones (A-E) indicating potential for clinical error. The Clarke error grid analysis uses a Cartesian diagram, in which the estimated/predicted values are displayed on the y-axis, whereas the reference values are presented on the x-axis. This diagram is subdivided into 5 zones: A, B, C, D, and E. The points that fall within zones A and B represent, respectively, sufficiently accurate and acceptable glucose results (better outcome), points in zone C may prompt unnecessary corrections, points in zones D and E represent erroneous and incorrect treatment.
During hospital stay (3 days - up to 30 days) measured in arm
Number of Nocturnal Hypoglycemic Events < 54 mg/dl (Between 22:00 and 06:00) by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of nocturnal hypoglycemic events < 54 mg/dl (between 22:00 and 06:00) will be recorded
During hospital stay (3 days - up to 30 days)
Number of Nocturnal Hypoglycemic Events < 54 mg/dl (Between 22:00 and 06:00) by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of nocturnal hypoglycemic events < 54 mg/dl(between 22:00 and 06:00) will be recorded
10 days post discharge
Number of of Hypoglycemic Events < 54 in POC Group by POC Reading Compared to CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Number of of hypoglycemic events < 54 will be recorded
During hospital stay (3 days - up to 30 days)
Number of Hypoglycemic Events < 54mg/dl by POC Reading Compared to CGM Reading
Time Frame: 10 days post discharge
Number of of hypoglycemic events < 54mg/dl will be recorded
10 days post discharge
Percentage of Patients With Greater Than 5%-Time Below Glucose Target <54mg/dl by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of patients with greater than 5%-time below glucose target <54mg/dl will be calculated. Only measured by CGM, Discrete POC values are not used to assess amount of time spent within a specific glucose range.
During hospital stay (3 days - up to 30 days)
Percentage of Patients With Greater Than 5%-Time Above Glucose Target >240 mg/dl by CGM Reading
Time Frame: 10 days post discharge
Percentage of patients with greater than 5%-time above glucose target >240 will be calculated
10 days post discharge
Percentage of Patients With Greater Than 5%-Time Above Glucose Target >240 mg/dl by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of patients with greater than 5%-time above glucose target >240 mg/dl will be calculated
During hospital stay (3 days - up to 30 days)
Glycemic Variability Calculated by MAGE by CGM Reading
Time Frame: During hospital stay (3 days - up to 30 days)
The average amplitude of glycemic excursions with values exceeding a certain threshold.
During hospital stay (3 days - up to 30 days)
Percentage of Patients With Greater Than 5%-Time Below Glucose Target <54 mg/dl by CGM Reading
Time Frame: 10 days post discharge
Percentage of patients with greater than 5%-time below glucose target <54 mg/dl will be calculated
10 days post discharge
Percentage of Dexcom G6 CGM Sensor Values Within 30/30% for Values 70-140 mg/dl Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 70-140 mg/dl range that meet %30/30 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 30/30% for Values 140-180 mg/dl , Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 140-180 mg/dl range that meet %30/30 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 30/30%for Values > 180 mg/dl, Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hyperglycemic range (>180 mg/dl) that meet %30/30 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Glycemic Variability Calculated by Standard Deviation by CGM Reading
Time Frame: 10 days post discharge
Glycemic variability will be calculated using Standard Deviation
10 days post discharge
Percentage of Dexcom G6 CGM Sensor Values Within 20/20% for Values < 70 mg/dl Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hypoglycemic range (<70 mg/dl) that meet %20/20 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 20/20% for Values 70-140 mg/dl Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 70-140 mg/dl range that meet %20/20 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 20/20%for Values > 180 mg/dl, Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hyperglycemic range (>180 mg/dl) that meet %20/20 accuracy criteria..
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 20/20% for Values 140-180 mg/dl , Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 140-180 mg/dl range that meet %20/20 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 15/15% for Values < 70 mg/dl Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hypoglycemic range (<70 mg/dl) that meet %15/15 accuracy criteria..
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 15/15% for Values 70-140 mg/dl Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 70-140 mg/dl range that meet %15/15 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 15/15% for Values 140-180 mg/dl , Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values within the 140-180 mg/dl range that meet %15/15 accuracy criteria.
During hospital stay (3 days - up to 30 days)
Percentage of Dexcom G6 CGM Sensor Values Within 15/15%for Values > 180 mg/dl, Compared to the Standard-of-care POC BG
Time Frame: During hospital stay (3 days - up to 30 days)
Percentage of CGM glucose values in the hyperglycemic range (>180 mg/dl) that meet %15/15 accuracy criteria.
During hospital stay (3 days - up to 30 days)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

February 21, 2019

Primary Completion (ACTUAL)

March 31, 2020

Study Completion (ACTUAL)

March 31, 2020

Study Registration Dates

First Submitted

February 5, 2019

First Submitted That Met QC Criteria

February 5, 2019

First Posted (ACTUAL)

February 6, 2019

Study Record Updates

Last Update Posted (ACTUAL)

August 5, 2021

Last Update Submitted That Met QC Criteria

August 3, 2021

Last Verified

August 1, 2021

More Information

Terms related to this study

Other Study ID Numbers

  • IRB00107627

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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