Continuous Glucose Monitoring Versus Capillary Point-of-Care Testing for Inpatient Glycemic Control in Type 2 Diabetes Patients Hospitalized in the General Ward and Treated With a Basal Bolus Insulin Regimen

Abstract

Background: Continuous glucose monitoring (CGM) may improve the management of patients with type 2 diabetes hospitalized in the general ward by facilitating the detection of hyper- and hypoglycemic episodes. However, the lack of data on the accuracy and safety of CGM have limited its application.

Methods: A prospective pilot study was conducted including 38 patients hospitalized in the general ward with a known diagnosis of type 2 diabetes mellitus (DM) and hyperglycemic individuals without a history of DM with a blood sugar of 140-400 mg on admission treated with a basal bolus insulin regimen. Inpatient glycemic control and the incidence of hypoglycemic episodes were compared between detection by CGM of interstitial fluid for up to 6 days and point-of-care (POC) capillary blood glucose monitoring performed pre- and postprandially, before bedtime and at 3 am.

Results: No differences in average daily glucose levels were observed between CGM and POC (176.2 ± 33.9 vs 176.6 ± 33.7 mg/dl, P = .828). However, CGM detected a higher number of hypoglycemic episodes than POC (55 vs 12, P < .01). Glucose measurements were clinically valid, with 91.9% of patients falling within the Clarke error grid A and B zones.

Conclusions: Our preliminary results indicate that the use of CGM in type 2 patients hospitalized in the general ward provides accurate estimation of blood sugar levels and is more effective than POC for the detection of hypoglycemic episodes and asymptomatic hypoglycemia.

Keywords: continuous glucose monitoring; hyperglycemia; hypoglycemia; point-of-care testing.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AMG reports speaker fees from NovoNordisk, Elli Lilly, MSD, Novartis, and Medtronic and research grants from Medtronic, Novartis, and Abbott. CR receives fees for a patient education program with NovoNordisk and insulin pump patient training with Medtronic. PA has participated in advisory boards and has received speaker fees from AstraZeneca, BMS, Boehringer, GSK, Jansen, J&J, Lilly, MSD, Novartis, and Sanofi and has participated in original research involving Sitagliptin and insulin Glargine.

© 2015 Diabetes Technology Society.

Figures

Figure 1.

Average daily glucose measured by CGM and POC. Average glucose measured by CGM or POC glucose monitoring at bedside during the first 6 days of hospitalization. The red line represents CGM measurements and the green line represents POC measurements.

Figure 2.

Clinical accuracy of blood glucose levels measured by continuous glucose monitoring. Clarke error grid comparing blood glucose levels measured by CGM and POC. The grid predicts the type of clinical error that can be committed when there is a difference between the 2 assessment methods. Differences that fall within the A and B zones indicate the lack of clinical consequences.